Once again I have written a blog post about my revulsion at the deadly behavior of UK midwives, and once again a prominent midwife has rushed to demonstrate the truth of my words to the entire world: professional autonomy is more important to midwives than whether babies live or die.

Sheena Byrom is the poster child for moral depravity in the face of preventable infant deaths.

The number of claims for brain damage and cerebral palsy has tripled in a decade, amid widespread monitoring failures …

The cases – often linked with a failure to monitor babies’ heart rates, to detect risks of oxygen starvation – fuelled maternity negligence claims of more than £1.2bn in 2015/16 [$1.5 billion].

The proximate cause is that UK midwives are not adequately trained in fetal monitoring, but the real cause is that UK midwives place process (“normal birth”) above outcome (live, healthy babies and mothers).

Just in case you thought I was exaggerating the immorality of a group of medical providers who place their personal philosophy above the lives they are ethically mandated to protect, midwife Sheila Byrom rushes to prove me right.

Byrom is the poster child for moral depravity in the face of preventable infant deaths. She has the unmitigated gall to defend the unethical behavior of midwives in privileging process over outcome by arguing that it is more important to preserve “normal birth” than human life.

In my piece I asked: how many babies have to die and how many billions of pounds have to be paid out before the morally repugnant, incompetently trained, self-dealing, deadly UK midwives are held to account?

Sheena Byrom, writing in conjunction with another deadly midwifery enabler, Soo Downe, answered: as many as UK midwives damn well please.

Midwives will be told not to use language that could push women into “normal” birth amid fears that babies are at risk because of a reluctance to ask for medical help…

A review into the deaths of 11 babies and one mother at the Morecambe Bay trust warned that a desire for normal birth “at any cost” was a contributor.

Outgoing head of the Royal College of Midwives (RCM) Cathy Warwick has met every new midwifery scandal with weasel words but no action. Speaking of the most recent scandals, Warwick offered more weasel words:

[I]f there were midwives who were pushing normal birth then we must have good governance process in place which will pick up that and make sure it doesn’t continue to happen.

Byrom and Downe also use weasel words:

Promoting normal birth while also maximising the wellbeing of mother and baby is therefore not a cult, or a professional project, or a conspiracy. It is a moral and ethical imperative, that should be supported by all of those with any interest in the wellbeing of mothers, babies and families, in the short and longer term. This includes professionals, journalists, politicians, health service managers, childbirth activists, and lawyers.

But no one is talking about promoting normal birth while maximizing wellbeing of mother and baby; the issue is promoting normal birth above maximizing wellbeing of mothers and babies.

Byrom and Downe present a graph that demonstrates a slowly rising C-section rate and ask:

And if there is a widespread problem where midwives ‘pursue normal birth at any cost’, why are the statistics below so stark? Surely, the opposite would be the case?

Which words in “claims for brain damage and cerebral palsy has tripled in a decade” and “maternity negligence claims of more than £1.2bn in 2015/16 [$1.5 billion]” are they having trouble understanding?

Byrom and Downe insist that “normal birth” is a moral and ethical imperative.

Respect for autonomy – the patient has the right to refuse or choose their treatment.

Beneficence – a practitioner should act in the best interest of the patient.

Non-maleficence – to not be the cause of harm…

Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment …

Do you see normal birth — or any specific procedure — among these? I don’t either.

The key to understanding midwives’ insistence on a procedure instead of an outcome is to recognize that when midwives say “normal birth” what they really mean is “anything midwives can do and nothing they cannot.” Promoting normal birth is really about promoting midwife autonomy.

In their first paragraph Byrom and Downe make it clear that this is really about midwives and their desires:

Yes, there needs to be learning from incidents, and development where needed. But blaming one professional group, or a particular type of birth, does little to improve any situation.

Actually, insisting that a professional group take responsibility for their own deadly mistakes does A LOT to improve any situation.

I regularly spend time with student midwives from around the UK and beyond. They tell me they are worried about practising as qualified midwives, as, during their training, they hardly ever see women who have had a normal, physiological, straightforward pregnancy, labour and birth.

Midwifery is NOT supposed to be about meeting midwives’ needs; there is a moral imperative to meet PATIENTS’ needs.

Recent press reports add to the fear already embedded in maternity services. This fear is real in high income countries, and influences the decisions of women, mothers and families alike.

But the ethical provider SHOULD feel fear at the thought of preventable deaths. It is only the morally bankrupt who would counsel otherwise.

Byrom, Downe and Warwick have blood on their hands and the reason is very simple: they continue to promote THEIR interests — the process of “normal birth” (or, more accurately, midwife autonomy) — above safe outcomes for mothers and babies.

As long as UK midwives are allowed to indulge their desire to serve their own interests, babies will continue to die and the NHS will continue to pay out billions of pounds to grieving parents. That is truly immoral and unethical.

I’m not sure how I ended up reading this blog, but I don’t care~this is a well-done article. As a high-risk OB patient, gravida 6, I fully agree with the author. These midwives are performing their jobs; but they literally have LIVES in their hands. There is nothing in this life that is worse than the death of your child, except losing your child and your wife at once, I guess. If I was a midwife, I would be worried about grieving parents who have nothing to lose finding out that my highest priority was not the safety of their child.

rosewater1

It really makes no sense to me . NCB advocates are EXACTLY what they profess to detest. They themselves shackle women into their idea of how birth must be. How if you don’t choose a natural waterbirth with a midwife, etc, etc, you are Doing It Wrong.

And when they are confronted with their BS, they insist that no, that is not at all what they mean! They are telling us the TRUTH!

The truth is…women who choose-CHOOSE-a medicated hospital birth-or a c/s-can actually be trusted to know what they are talking about. We are trusting these same women to raise the child to adulthood. But yet they have to be “guided” into making the choice for how the baby is born?

It is paternalistic and condescending.

I don’t expect what I wrote to change anyone’s mind because they don’t WANT their mind changed. The information isn’t just available for THEM. Anyone can read stories about the glories of unmedicated birth, or waterbirths, or anything else NCBers say is so wonderful. And if they decide after knowing the options that they don’t want that…respect that.

Jacob Bunton

No one is telling you how to birth your baby rosewater1.
Choice – real choice – is what is important.
That goes for BOTH the woman who requests a CS or a woman who requests a waterbirth – (and every other choice in between)
Absolutely no one should feel threatened, belittled or judged for THEIR own choice. Certainly no one should be exposed to the abuse women have experienced when sharing how they wish to birth.
Dr Amy Teuter and many others have been a part of this as I am sure other groups on the polar opposite ie. Natural birth movement have also attacked. This gets us no where.

rosewater1

Then why are you here? This post is full of you belittling and shaming and disrespecting other commenters who have told you that they do not agree with you. But no, you know better, and by God, you’ll keep telling us until we get it through our pretty little heads.

And you’re doing it deliberately. You love the attention you’re getting here. Why else would you keep coming back.

I’m 51 years old. But even when I was 15 I knew what patronizing sounded like.

Save your sanctimony, Jacob. It’s wasted on me.

Heidi_storage

Could you try to spell Dr. Tuteur’s name correctly? It’s a bit distracting to see it spelled wrong in various places, and whether or not you intend it also communicates a certain lack of respect that you don’t bother to get it right.

Jacob Bunton

Sorry. Dr. Tuteur.

Amazed

I’m putting this up here, so it won’t get lost in the comments.

To Jason Bunton: Listen you fucking filth! If you can wax your lyrics
about you great martyr – which is a sample size of ONE – one idiot and
one woman lucky enough to have survived your care, you can at least
acknowledge other people’s evidence of what happened to THEM.

You’re all for anecdotes when they paint you as this great savior and your
bullshit as the greatest thing ever but not when people tell you what
happened to them, right? I mean the horror moto librarian LIVES every day because she had a glorious natural birth.

You’ve already posted that. It did not support the claims you have made ( lotus birth DCC in particular). Spamming now?

Jacob Bunton

I did not mention lotus birth, you did, so you better research what it is. Cutting the cord after a physiological third stage (i.e once the placenta has birthed) is not a lotus birth.

yugaya

“so you better research what it is”

Ignorant AND arrogant in his ignorance. Here, RCOG definition: “Within a short time after birth, once the umbilical cord has stopped pulsating, the placenta has no circulation and is essentially dead tissue.”

Do I have to spell it out to you yugaya? Geez. Your ignorance is blinding. Physiological third stage can happen in 10 mins, ok placenta now out, pick up a pair of scissors before you have a heart attack and cut the cord. Ok. We clear. This isn’t a lotus birth. No one is talking about lotus birth. Just you.

MaineJen

Yeah, lotus birth. Hahaha! That’s just crazy.

Now sea mammal birth, on the other hand…

Nick Sanders

Hey buddy, my wife is a sea mammal!

Heidi

Um, if mom is about to have a myocardial infarction, I’m really thinking she shouldn’t be having a “physiological 3rd stage” birth with midwives. Probably need quite a few specialists up there.

momofone

“Your ignorance is blinding.”

Well, someone’s certainly is.

yugaya

” Physiological third stage can happen in 10 mins”
But those midwives that “know” wait a whole lotta longer, don’t they?

From your earlier crap: ” Then awaits the birth of the placenta. The midwife knows it is not wise to mix active management with physiological third stage, as this increases risk of PPH.”

The midwife WAITS. And WAITS. Often for hours, right? Because active management of third stage is ebil.

I’m not sure at this point that you are even aware of how much ignorance you’ve displayed.

Look buddy, it’s been fun to entertain the latest troll but the thought that you are in active charge of pregnant women and their care in childbirth is scary AF.

Key recommendations regarding maternal deaths from hemorrhage in UK:
– Antenatal care and abnormal results (Iron deficiency anaemia not only reduces the tolerance to acute haemorrhage but may also contribute to uterine atony because of depleted uterine myoglobin levels necessary for muscle action.)

-Underestimation of blood loss in smaller women

-Communication, Ownership, Leadership and Teamwork (the main problems identified with communication involved •disagreements in estimated blood loss in three women •lack of communication of concerns regarding blood loss in five women •not escalating to a senior when their condition deteriorated in two women)

-Recognition of haemorrhage and the deteriorating woman.The severity of the situation was not recognised in11 women (61%).

A link is not a response to a request for scientific information confirming your claims. State the claim that then quote the relevant passage from the appropriate scientific paper.

Jacob Bunton

Dr. Amy Teuter why have you deleted my message as Spam? And the other awaiting approval? Am I ruffling your feathers

Amy Tuteur, MD

I’ve deleted nothing and I don’t see any of your posts as flagged or in moderation.

Jacob Bunton

That’s good, just checking! I saw something flash up deleted as spam.
This tagline I get sometimes though is a bit annoying….’Hold on, this is waiting to be approved by The Skeptical OB.’ What exactly are you approving?

Amy Tuteur, MD

Everything is automatically posted immediately unless it contains a lot of links or scatalogical language. Then it is flagged for me to read; in addition, readers can flag comments that they find offensive.

The Computer Ate My Nym

You are making unfounded and highly emotional accusations. Perhaps that is because you realize you are in the wrong and are trying to defend your position in the only way you can: by becoming angry and defensive.

Jacob Bunton

She’s done it before.

momofone

Proof please.

Heidi

Again, doubtful. Unless you’ve said something even more patronizing, offensive, or stupid, and at some point, enough is enough. Disqus doesn’t necessarily show every single comment and can get clunky.

yugaya

Bullshit. None of your rubbish comments have been deleted.

Roadstergal

Why on earth would she delete your comments? Just letting you blather on about your superior superiority in all things, while demonstrating with every post your profound ignorance about anatomy, physiology, the birth process, history, and the internet, is the best anti-Jacob Bunton PSA there could be.

The Computer Ate My Nym

That seems highly unlikely. I don’t think you’re thinking very logically about it. Why would Dr. Tuteur delete some of your messages at random when she’s shown herself willing to let you post here at all? A logical thinker would ask whether the posts that were deleted had some problem, i.e. links that held it up automatically per disqus policy. A modest person might wonder whether they had, perhaps unintentionally, violated posting policy, i.e. by using unacceptable language or advertising not consistent with the policies of the blog owner. Only an overly emotional man would jump straight to the assumption that he is being martyred. But so few men are good at things like logic and science. I expect you can’t help it.

Nick Sanders

Ouch! That was beautiful!

Jacob Bunton

Dr. Amy why is the below comment awaiting to be approved?

Jacob Bunton

A ‘safe birth’ is predictable
A woman in spontaneous labour is quite predictable.
The midwife knows that if the woman feels relaxed her labour will progress.
To facilitate this relaxation the lights are dimmed, the environment is calm and private. The midwife knows the risks of disturbing a woman in labour and has faith that the woman will be able to birth her baby and if not the midwife knows when to offer assistance.
For instance, if the woman is in the pool and her labour slows after 2 hours, the midwife can ask the woman to mobilise.
When the woman wants to push, the midwife does NOT say you must wait til you are 10cm. The midwife explains, that when baby is close its an overwhelming feeling, you cannot help but push.
When the woman is actively pushing, the midwife knows it is not safe to shout at her ‘push push’ and adopt the valsalva technique, as she knows that prolonged breath-holding decreases placental perfusion resulting in fetal hypoxia and decreased fetal cerebral oxygenation. It also increases the risk of 3rd degree tear, particularly if the woman is squatting in the pool.
The midwife checks the pool and ensures the temperature is not more than 37.5 degrees because if too hot i.e 38.5 she/he knows it can cause problems for the baby.
The woman is relaxed between (and often during) contractions, once it has passed the midwife gently asks her to move onto all fours or kneeling with her head rested on towel on edge of pool. The midwife knows there is a small risk of shoulder dystocia so she/he wants the woman to be in a position that best maximises the width and opening of her pelvis. The midwife also knows in this position the woman will find bearing down easier, experience less severe pain and will have a shorter second stage.
The head is born.
The midwife knows not to put her hands in the pool, as that risks stimulating the baby to breathe. She/he uses ‘hands off’ for delivery.
The baby is born with the next contraction.
The midwife (sometimes the mother) slowly and gently lifts the baby out of the water.
The midwife knows that a woman is more likely to have an intact perineum or a small tear birthing in the pool but she/he knows how to suture a 2nd degree tear if needed.
The midwife knows there is a risk of PPH (haemorrhage) so she puts the baby skin to skin, this aids breastfeeding and reduces risk of PPH. If she bleeds the midwife knows what to do just like the doctors, both have the same training in all obstetric emergencies.
The midwife knows the placenta may fall out as the woman stands to get out the pool, so she provides a bowl and the placenta falls into it. If not, she asks the woman to empty her bladder. If she can’t the midwife offers an’ in out’ catheter. Then awaits the birth of the placenta. The midwife knows it is not wise to mix active management with physiological third stage, as this increases risk of PPH.
Midwife does not disturb the mother and baby, and keeps the room calm and quiet as this facilitates oxytocin release for both the mother and baby, nor does she cut the cord. She waits until the placenta is birthed.
From birth and until an hour post birth the baby is kept warm skin to skin with the mother, the midwife knows that babies can easily lose heat, so baby being skin to skin baby will copy the mothers temperature. Both are then covered in warm towels and blankets. This also helps prevent a PPH.

I can see how you may have missed my question about MRCS–it may have buried in the other comments–but I’d like to know what your thoughts are/how you handle it if the mother declines all of the above and requests a c-section.

Thanks!

Jacob Bunton

This is a good question.
Now I need to be careful re: confidentiality.
Many years ago I cared for woman x, I was studying at the time, so x became one of my continuity of care women. She had been in several foster homes, of these she was sexually abused in x of them. In the meeting with the midwife, woman x said she wanted a MRCS, the midwife replied ‘no, we don’t offer MRCS. Its against policy’ I protested on x’s behalf, ‘but surely it must be the woman’s choice!!’. The Midwife gave me a pitiful look and said ‘sorry, no’.
I privately spoke with the midwife after the antenatal appointment and asked her ‘given this young woman’s history, don’t you think we should consider her wishes?’ The midwife eventually sighed and said ‘listen you can speak to the Head of obstetrics if you want, but she will also tell you its a no.’
I arranged an appointment and x and I attended a meeting with Dr. x obstetrician and clinical director of the maternity unit. Dr. x spent hour an hour with us. First listening to x’s wishes, then Dr. x explained in detail the benefits of CS and a longer list the risks (to be honest I didn’t know there were so many risks, I thought it quite a common, straight forward procedure). Dr. x then explained the risks and benefits of vaginal birth. Throughout woman x insisted on having a CS. Dr. x replied ‘ok on one condition, you do some homework for me, go home and look at the research. Once you have done that we’ll meet again.’ Woman x I was now seeing regularly, attending appointments with her, we chatted a bit about birth, only if she asked me but mostly talked about everything non-related to birth music, shows on TV etc. She did ask me once though, how do women have an easy birth? I replied ‘I don’t know? I have heard from women that being in the shower helps, some say they were able to get in the flow more being on their own. I read also that bright lights can sort of wake you up, maybe more stressful I guess. I don’t know, sorry?’ We met Dr x 3 weeks later, woman x had made her decision she wanted a MRCS. Dr. x wasn’t happy bout it but accepted her choice, asked her to sign a consent form and the plan was made and a c-section date booked. 3 weeks later, I got a text message the night before woman x’s c-section booked for 6am the following morning. Woman x texts me ‘I am going to the hospital, can you come?’, I grab my keys, next text message I read running up the hospital stairwell, ‘midwife says I am fully.’ What the hell! I arrive on labour woman x is on the bed, semi-recumbent position. The midwife appears at a bit of a loss, she has not met woman x before, I explain in private woman x history. The midwife says ‘well I guess the choice is hers’. We both enter the room, I say to woman x, ‘you absolutely can still have a c-section if you want.’ The midwife nods in quiet agreement. Woman x looks at me and says ‘well I’ve come this far, I might as well do it.’ With the next contraction she starts spontaneously pushing and delivers a bonnie 8.8 pound beautiful baby. After the birth, I asked woman x what happened at home? I wanted to say ‘what the hell just happened!!!? but though we had become friends, I thought I should keep some level of professionalism. She just shrugged, you know how you said ’bout shower, keeping it dark..’ I vaguely remembered, ‘well I did just that.’ I replied ‘On your own??!!’ Yes in the bathroom, on my own. ‘Did you know you were in labour?’ I guess I knew something was happening. It was ok. I just figured it was braxton hicks.’ When did you realize it wasn’t!? ‘When I really really wanted to push.’
Dr. x arrived just after the birth in a flurry of excitement. I’ll never forget that moment of Dr. x meeting woman x. She had my full respect, they both did.

A year later, I was no longer in the country, woman x emailed me ‘I have good news I’m having another baby I’m x weeks and due x I’m going to go natural with this baby as well. It’s going to be a handful with two. Please keep in touch would love to keep in touch. As you were a big part of mine and baby x’s life.’

Not too long ago, at a booking with a woman having her first baby she anxiously asked me if MRCS were possible at x hospital. I gently asked her, her reasons for requesting a CS. She replied ‘I have a fear of birth. I have done my research. CS is safer than vaginal birth.’ This woman was educated, she quoted me statistics, and spoke eloquently. I reassured her that though we wouldn’t normally routinely agree to an MRCS her wishes would be heard and respected. I excused myself for a few moments and asked the senior midwife, she told me, ” woman x, absolutely would not be allowed to have [MRCS] because she has no medical problem that would warrant it.” I explained to Francis that I had cared for a young mother in x and we had discussed her wishes of an MRCS with the Consultant obstetrician. Midwife x advised me to refer her to Consultant Midwife.

At hospital x there is a clear referral pathway for all women requesting care outside the recommended guidelines. For example a VBAC wanting to use pool in the AMU, history of PPH over 1L wanting to use AMU, MRCS. Woman x met with the Consultant Midwife for over an hour and they together with also the Consultant obstetrician’s input discussed the risk and benefits of all options and a individualised plan was made and shared with the team.

I met with x ….. to explore her wish to have an elective Caesarean. We discussed and explored x’s thoughts, feelings and wishes. X explained…her reasons for this are:

* Feels that an elective Caesarean is safer and more controlled than vaginal birth.

* Nervous about getting postnatal depression (following her x’s experience) and feels this is more likely to happen with a complicated vaginal birth.

* Concerned about instrumental birth and injury to her or baby.

* Anxious about having vaginal/perineal trauma and this leading to problems with her bladder/bowel.

* Researched her options and whilst her ideal birth would be a natural water birth she does not feel this is a reasonable/realistic outcome for her as she is concerned about being in pain and would likely opt to have an epidural.

We addressed each of these concerns individually and discussed the advantages and disadvantages of vaginal birth and elective Caesarean section. I explained the reasons why we would strongly not recommend a Caesarean section without a medical indication for there is an increased risk of: thromboembolism, infection, bleeding resulting in hysterectomy, complications in subsequent pregnancies, anaesthetic and surgical complications (including potential bladder/bowel injury), increased length of hospital stay and recovery and baby being admitted to the neonatal unit for respiratory problems. We explored the potential medical benefits with a planned Caesarean section, such as a possible reduction in: abdominal and perineal pain during the birth and up to 3 days postpartum, vaginal/perineal trauma, early postpartum haemorrhage and obstetric shock.

I explained that there is an increasing amount of evidence that suggests that exposure to the normal flora in the vagina that occurs during a vaginal birth is of benefit for life-long health. Whilst it is difficult to establish the true extent of this benefit the evidence suggests higher rates of childhood respiratory and gastro-intestinal illnesses, allergy, and also weight issues in individuals who were born by elective Caesarean section compared to those born vaginally or by emergency Caesarean section during labour.

I explained that bladder and bowel injury is not exclusive to vaginal birth and can happen with Caesareans (although uncommon) and whilst most women will experience some bruising or tearing to the vagina/perineum with vaginal birth the majority of these heal well without complications. Only a small proportion of women will have a severe tear (third or fourth degree) and the majority of these also heal well without any ongoing or long term problems. I explained that occurrence rates of these types of tear vary; some studies suggest a prevalence of 3.8% with first time mothers and 2% of second time mothers and a recurrence rate of severe tears of approx. 7%. Whilst it is hard to predict what will cause a tear of this nature there are some associated risk factors such as:

* Previous third/fourth degree tear

* First baby

* High birth weight

* Shoulder dystocia

* Advanced maternal age

I explained that because it is difficult to absolutely predict it can be hard to prevent it from happening again, however there are certain practices which have been found to be beneficial when caring for the perineum such as:

* To offer the application of a warm compress in the second stage of labour as this may reduce perineal trauma.

* It may be appropriate and have some benefit to avoid standing birth positions and the use of the birthing stool in the second stage.

I have shared with x our hospital/local figures regarding our Caesarean section, instrumental, normal birth and third/fourth degree tear rate. In addition I have provided x with and discussed with her the RCOG written information on Instrumental Birth and Caesarean section and the Birth Place Study Decisions leaflet (2014). We went through the key findings from the Birthplace Study (2011) including the likelihood of having a Caesarean in labour, instrumental birth, uncomplicated vaginal birth and having a baby being born with a poor outcome in each birth setting. http://www.nhs.uk/Conditions/pregnancy-and-baby/Documents/Birth_place_decision_support_Generic_2_.pdf

X is aware that most women and their babies who are at low risk of complications recover well from birth however there are additional risks to consider for both her and baby with a Caesarean. In addition having a vaginal birth means she is more likely to be able to have skin-to-skin contact with her baby immediately after the birth and breastfeed successfully, the recovery is likely to be quicker and she should be able to resume her normal activities/drive sooner and subsequent births are likely to be more straightforward.

We discussed how we can best support her in view of her fears and our recommendation, such as supportive birthing planning to seek solutions to certain elements that cause her particular concern, which she has after some thought over the weekend, declined with thanks. Whilst x understands the risks associated with having an elective Caesarean she feels this is the safest/right option for her and baby.

On speaking with x today she reports she is feeling less anxious and is actually excited for the first time about the birth with the prospect of having an elective Caesarean.

Please do not hesitate to contact me if you have any questions,

With Best Wishes

Yours sincerely

XX Consultant Midwife

Woman x met with the obstetrician a CS date was booked and she had her baby via MRCS on xxx.

This is what I mean by informed decision making. And yes I absolutely do support MRCS, as I do any woman’s choice.

He probably thinks that if he puts long enough comments everywhere, we are going to forget that he first came here arguing that neocortical whatever and artificial light was the cause of all childbirth complication.

yugaya

Epic citation fail. The Birthplace study in no way supports any of that nonsense, especially the fucking lotus birth type of DCC:

“Midwife does not disturb the mother and baby, and keeps the room calm and quiet as this facilitates oxytocin release for both the mother and baby, nor does she cut the cord. She waits until the placenta is
birthed.”

Dr Kitty

I trained in the Coombe.
I think you’ve forgotten one, very, very important thing.
Patient satisfaction.
Women like going into hospital and knowing that 14 hrs later, one way or another, they’ll be holding their baby.
The Coombe had low CS rates, high VBAC rates, low rates of complications and the patients were highly satisfied. It was also all done with informed consent- women could decline AROM, pitocin, monitoring, epidurals etc. Few did though, because they listened to their friends and sisters and went with the recommendation to go with the advice of the team in the unit.

Women do *not* like long unmedicated labours, and pushing for over 4 hours only to end up with forceps or a CS..

I’m constantly horrified by the Postnatal discharges I get.
Hugely prolonged first stage without augmentation, followed by prolonged second stage, followed by forceps and tears or emergency CS for foetal distress. They have had epidurals only very rarely.
I see the women at six week Postnatal.

They are low risk women being cared for by NHS midwives.

They have been told by midwives during labour that baby was fine and that as long as baby was coping there was “no reason” to augment.
That they were coping “really well” with labour, and didn’t need epidurals, which might slow things down even further.
They usually only see an obstetrician at the very end of their prolonged second stage, when it’s all going pear shaped and it’s a decision between forceps or CS.
They certainly never had a proper discussion about the risks/ benefits of augmentation or regional analgesia during their labours.

They are damaged by the care they have received, because instead of early recognition that things are not going to schedule and steps being taken to ameliorate the situation, the attitude is that there *is* no problem. “Labour doesn’t have a schedule” and that doing nothing is the best way for everything just to naturally come right by itself.

I bite my tongue, but I know those situations are due to midwifery ideology, not patient choice.

It’s not the kind of care I would want for myself or anyone I. Aged about, because it actually looks like wilful neglect.

Dr Kitty

Sorry, “I would want for myself or anyone I CARED about”.

Jacob Bunton

I do not have the time now to fully reply, but just quickly.. how many waterbirths have you seen during your training? Are you ‘allowed’ to see waterbirths as a junior doctor? How many obstetricians have seen a waterbirth? How many Consultant obstetricians?

yugaya

Waterbirth – scam that a cult leader Russian psychopath came up with while having delusions of creating superior race because all children born in hospitals according to him are “disabled”.

The same psychopath later went on to claim that he can cure things like paralysis and permanent brain injuries in children by what can best be described as waterboarding technique – submerging the terrified child over and over again until completely exhausted. When one mother watching the “treatment” from outside the water started
screaming at him to stop, the guru sent her and her paralyzed son ( who was according to him “just starting to move”) off screaming after her that he cannot work with non-believers and that she should get used to having a sick kid.When asked by a journalist how he determines when a child has had enough of this “cure” he replied: “At that moment I get into an altered state ( of consciousness). I sense the limits and possibilities. It all comes down to whether you trust me or not.” He directly is responsible for multiple deaths of children whose mothers trusted him, both during births in his center and during such healing sessions.

3:30- Charkovsky delivers the baby, and the baby is “fine”, and then the father goes into the next room and calls his mother and THE BABY STOPS BREATHING BECAUSE PAST PIPELINE PSYCHIC MATERNAL LINES AND BAD JUJU and the reality of unseen connections. Not because a bunch of cult lunatics are pretending to be capable of delivering babies.

There are multiple testimonies by desperate parents who were tricked into taking their ill children to one of his seminars: “children would be after the session dragged to the shore sometimes vomiting salt water for hours, while some would just sit there terrified staring and not moving. Can you imagine an 8 month old child just sitting blankly without moving for 40 minutes, or a two year old screaming for several hours with a voice and vocal cords that have been
burned by all the salt…” ( unofficial translation of a testimony of a participant of Elena Fokina seminar – the lady in the baby yoga videos that are insane enough on their own). She was Charkovsky’s lover, student and associate) The supposed mechanism how this waterbording cure works is the same one Charkovsky uses to explain the magic of waterbirth – those multiple submergions are supposed to once the child “breaks” and starts breathing under water
trigger the cosmic mechanism by which the body will heal itself.

The part when it went from Charkovsky’s lunatic experiments in Moscow in 1980 to USA and global is equally disturbing- one of the first pioneers of it was
Gary Young ( of EOs fame), and he set up a waterbirth business in 1982. His own daughter died in 1982, another child was injured, and he had to skip town. His daughter was at the waterbirth that killed her submerged FOR OVER AN HOUR.

yugaya

I suggest google translate for this series of letters and articles that i found ironically in one of the books praising this lunatic, including by one of the top Russian OBs detailing the disasters they have witnessed that were directly attributable to Charkovsky, eleven waterbirth baby drownings during a single year … At the time when this was published Charkovsky already had several convictions and was claiming that he was not doing waterbirths. Russian health authorities were glad that he was no longer in the country and had escaped – to USA. https://translate.google.hu/translate?hl=en&sl=ru&u=http://a-naumov.narod.ru/books.files/book1/part1_1.html&prev=search

yugaya

“In Charkovsky’s view, as long as the umbilical cord has not been severed, the infant does not have to breathe through his lungs and can swim freely in the water. Afterward, too, when the infant is a few hours or days old, he should continue to be in the water as much as possible. In contrast to other methods that advocate the use of warm water to alleviate labor pain, in Charkovsky’s method, water is used to strengthen tolerance and endurance. Indeed, his method stipulates a preference for ice water, which will eventually make the infant a stronger and healthier person and strengthen the whole race.

From the evolutionary point of view, Charkovsky maintains, man’s origins are in the water, like all living creatures. He says that humans were
unfortunately pushed onto the land by “sea monsters” and thus imprinted with hydrophobia. The shattering of the physical taboos embodied in
Charkovsky’s method is intended to invoke primeval memories and instill people with superhuman spiritual, physical and intellectual capabilities.

Water births, according to him, are meant to make a significant contribution to human evolution – or, as he puts it, to create a “new race” of human beings. Furthermore, in the view of Charkovsky and his followers, infants who are born in hospitals are limited, even if they are described as being healthy.”

Jacob Bunton

I will read this section later. But regarding umbilical cord yes its easy to forget that the baby during pregnancy is actually in a sack of water. The umbilical cord keeps the baby alive. Birthing in water can therefore be a gentle transition in the world, the baby is kept alive by the umbilical cord and once taken to the surface, the cold air stimulates the baby to breathe. The baby will not breathe under the water unless stimulated, that’s why when baby crowning, Hands OFF, that is really really important.

yugaya

“The baby will not breathe under the water unless stimulated.”

Jesus Christ you are as insane as Charkovsky is.

Jacob Bunton

Yugaya please this is embarrassing not for me but for you and you sadly don’t even know it. Yes babies are attached to the umbilical cord for a reason. Why aren’t babies drowning in utero?

“There are several reports of death attributable to drowning resulting from poorly managed waterbirths and death, involving experienced midwives, in which asphyxiation and water-logged lungs made resuscitation of the infant difficult. The latter case led to the cessation of water births in Sweden.” …”multiple freshwaterdrownings attributed to underwater birth”

This is important point you have raised yugaya.
And topic for further discussion.
If obstetricians are seeing one waterbirth if they are lucky. If mws during their training also see a limited number and mostly care for women with an epidural. Then who will attend the waterbirth? The overmedicalisation of childbirth, can result in a skill loss, and make birth dangerous.

Amy Tuteur, MD

Waterbirth is deadly nonsense promoted by midwives because they unable to place epidurals.

Jacob Bunton

OMG Amy just when I was beginning to have some respect for you. You are an ex-obstetrician, stay that way!

Nick Sanders

Why would anyone want your respect?

Amy Tuteur, MD

Please provide scientific evidence that waterbirth is safe; the scientific literature shows that it kills babies through fresh water drowning, water intoxication, cord avulsion and Legionnaire’s disease among other things.

There is no primate that delivers in water. There is nothing natural about waterbirth. It’s just midwifery nonsense meant to disguise the fact that midwives aren’t capable of managing labor pain.

Jacob Bunton

This post is for you Dr. Amy.
Its so far down the comments page most of your groupies won’t see it. Probably a good thing because they’d go ape shit!

Primate – now that’s where you are going wrong. We in fact have more in common with sea mammals.
Yes really!
Human beings have traits not specifically human only. We often share with other mammals.
You’d agree Dr. Amy that what makes human beings special is our huge brain mass.
3 x that of chimps.
Brain mass of dolphins 2 x that of chimps.
*** Our brain mass similar to sea mammals ***

Because of our huge brain humans have specific nutritional needs in terms of fatty acids, omega 3.
*** Food – seafood chain***
Most widespread nutritional deficiency is Iodine. Important for the synthesis of thyroid hormone and development human brain. You know this, so we agree right?

American Thyroid Association (ATA) recommends all pregnant women take supplement of Iodine 150mcg. They say babies I.Q then increases by 1.22 after taking 150mcg . Those who eat from seafood chain only ones who have enough.

*****Vernix caseosa******
Babies covered in the stuff at term.
Aquatic mammals also
Full of cellular sponges and fatty acids
“waterproofing” function of vernix, thereby preventing heat loss soon after birth
Role is protective
In case of sea/water immersionhttps://en.wikipedia.org/wiki/Vernix_caseosa

Mammals eat the placenta
1970s took flight with women and today as you’ve probably heard some women choose placental encapsulation though there is no evidence for it.
Almost universal among non human mammals

***whales and dolphins are exceptions, they do not eat the placenta ******

Desmond Morris coined the term ‘Naked Ape’ in his book. Mammals are covered in hair
**** Except sea mammals ********

Humans have a layer of fat to get to fascia not with a gorrilla.
**** Dolphins, whales, seals, like us have a layer of fat. *******

We are not as unique as we think we are.

Humans have a low larynx so we can breathe with our nose or mouth.
****** Same as sea mammals ********

Was man more aquatic in the past?
Marine chimp?
Huge topic…even when you start exploring evidence 50000 years ago, colonising the pacific rim, geneticists say reached these areas Australia, Japanese archipelgo, Alaska etc via ‘coast’ not ‘corridors’. Not strange if you consider the sea level 20000 years ago was 130m lower. Means that between China, Australia, S.E Asia, Polynesia and Chile there were many islands.

We at a turning point in our understanding of human nature. So much yet we are still to discover.

Does this mean all women should have a waterbirth? No! of course not. Is epidural wrong. No! But to say there is nothing natural about waterbirth. Is misguided.

Waterbirth isn’t new. The indigenous tribes of Australia, the Amazon and other parts of the world have birthed in water for thousands of years.

Tea tree lakes, in Australia for example was sacred to indigenous women as a birthing place. Tea tree has wonderful antiseptic qualities so the women were said to birth and wash in the tea tree infused water.

Roadstergal

Given the profound ignorance you’ve shown regarding what amniotic fluid is and how placentas work – not to mention your profound misogyny – I’m surprised you think anyone is going to give your water birth obsession a jot of credibility. Keep at it, though – you might turn a few more women off of it, which would be quite a plus.

Azuran

Oh sure, if an indigeous tribe does it, it must be the recommended path. The old noble savage trope.

Jacob Bunton

‘noble savage’ wow still a lot to learn young one. Recommend the ‘last hours of ancient sunlight’ by Thom Hartmann

Azuran

I certainly have nothing to learn from a patronizing imbecile who think we are freaking sea mammals.

Honestly, I’d be more concerned about candiru than piranha if giving birth in the Amazon.

Jacob Bunton

“Everything is theoretically impossible, until it is done. One could write a history of science in reverse by assembling the solemn pronouncements of highest authority about what could not be done and could never happen.”
― Robert A. Heinlein

Really? Then surely you have some scientific references. Please share them.

Jacob Bunton

Indigenous and Western epidemiology are worlds apart….clearly

Roadstergal

Ah, the old fall-back racist trope. As if the Indonesian, Chinese, Indian, and Native American scientists I worked with were somehow less competent to do the scientific method than Caucasians.

Jacob Bunton

No one is saying that.
Its about Western and Indigenous epistemology, how we see the world. Equally of value. Sadly the Western epistemology, world view dominates. That is a big mistake.
And may be our undoing.
See ‘Last Hours of Ancient Sunlight’ by Thom Hartmann

Much like turtles, Jacob Bunton is racist mansplaining all of the way down.

Heidi_storage

Indigenous to what? Are we still talking about Australians? “Indigenous” people have different epistemologies, y’know. People indigenous to, say, Scotland have vastly different perspectives than do the !Kung.

Lilly de Lure

Hmm – are you an aboriginal australian yourself? If not who the hell are you to tell us (or anyone) what their culture (or any other indigenous culture) can tell us? Like all cultures indigenous ones are made up of people who are perfectly capable of saying (or not saying) anything they like without the help of an outsider fetishing them.

Jacob Bunton

Who are YOU! To tell me what and who I am. ??
I think maybe you should keep your mouth shut on this one.

As to a previous poster who described indigenous culture as ‘primitive culture’ may I just say to you
‘You can’t say civilisation don’t advance… in every war they kill you in a new way.’

Lilly de Lure

I am someone who knows better than to hijack aspects of indigenous cultures (or rather plagiarise someone else who did so since you evidently don’t have the imagination to do so yourself) to try to protect a scientifically untenable position from criticism.

Jacob Bunton

And that’s about all know….

Jacob Bunton

Your statement above perfectly highlights the stark difference between Indigenous and Western epistemology.

Many would say there is much you don’t know.

Modern obstetrics has been around for approximately 150 years, Australian indigenous culture for over 40 000 years.
Your world view is a blink of an eye.
Yet you naively follow it without due reflection or question.

At every point of modern obstetrics, there has been a realisation that what is being done is wrong, or even dangerous.

I guarantee you this Dr. Amy Teuter that there are practices being done and drugs being administered right now in obstetric units globally today, in the misplaced belief of doing no harm which will be discovered in the near or distant future (depending on how many brave souls there are to speak out and question the views of such a self important institution) that there are things being done in the name of safety which are doing harm, these practices will be stopped, just as they have in the past.

We have not yet ‘arrived’.
Despite all the claims of safety and the arrogance of the profession maternity services today is nothing to be proud of.

It may well be time to listen to our Elders and their ancient knowledge and wisdom. They must have done something right.

If you’re an example of an Elder with whatever, I’ll leave it for now, thanks.

There are plenty of ‘brave souls’ such as yourself crying out against modern medicine, vaccination and climate science. Lucky for you there are plenty of fed up people ready to ignore reason for the sake of all their rights and freedoms. Secure knowing the safety net of modern medicine and science is there to catch them when things don’t go according to plan.

Someone who is flogging their services as a birth attendant and thinks the reason waterbirth is safe is because a baby breathes through water in the womb is a disgrace.

Heidi_storage

“They must have done something right.” Yeah, I bet their maternal/infant mortality statistics were amazing compared with ours.

Jacob Bunton

Yep they probably were.
Until the rest of the world figured out how to dominate nature and everything and everyone else

Azuran

‘Probably’
So, you have no proof, you just decided that they were, and are pushing some agenda based on some statistic you don’t even have.

Nick Sanders

Spoken like someone who can’t even conceive of the meaning of “red in tooth and claw”.

Since white supremacy took over, children were stolen from their parents, laws, ‘aboriginal sacred law’ ignored and disrespected, lands where life, human and otherwise thrived was called ‘No mans land’ and taken away. Populations massacred….I don’t think I need to go further or speak to you, an American who country’s past is responsible for the mass murder and genocide of Native Americans.
Nor have the respect to teach it in all schools.

Azuran

As horrible as history is, this has nothing to do with the safety of birth nor does it prove some ancestral safe way of giving birth.

Jacob Bunton

Aboriginal women still don’t have the right or choice to birth on their own lands. They are taken far away from their communities, weeks prior to the birth and are forced to give birth in high rise hospitals far from the earth.

Azuran

Well, first, how far from the earth they are does not affect birth in any way.
And the treatment of aboriginal women is an entirely different story from how we should give birth. Yet I somehow doubt that birth police are kidnapping aboriginal women and locking them up in hospitals for weeks until they give birth.

Jacob Bunton

‘how far from the earth they are does not affect birth in any way.’
Maybe not for you, but it does if its your belief system. ….

No, actually, it doesn’t. If you believe that you have to give birth while lying on dirt, but give birth in a hospital, you won’t get any additional complications. I agree that choice is vital- kidnapping women is absolutely never okay- but no, beliefs aren’t actually impactful on reality that way.

Azuran

Well, since birthing close to the earth does not MEDICALLY matter. Anyone who cares about this that much can either find another hospital with the labour ward on the ground level or birth at home.

AnnaPDE

My hospital is built on a steep hill, and its labour ward was ground level from one side and inside the earth from the other.
Why do they even bother to have doctors on staff that close to earth, right?

Azuran

Clearly all my problems during labour where because the labour ward of my hospital was on the third floor.
My water probably also broke before my labour started because the main floor of my house is slightly above ground level as well.

Daleth

See, Jacob, to me, it doesn’t matter whether an idea is 40,000 years old or 150 years old or two weeks old. It matters whether the idea is true.

And when it comes to ideas about health and medical care, all I care about is whether the idea actually in real life increases the chances of health and life, or increases the risk of injury/ill health or death. In other words, is the idea “X is better for pregnant women/newborn babies/etc.” true or not?

You can cite all the colonialist, “primitive culture”-fetishizing birth-related mumbo jumbo you want. People who care about truth will ignore it and instead look up statistics on maternal, perinatal and neonatal morbidity and mortality in that culture/country. IF, and only if, those statistics are comparably good to ours, THEN truth seekers will consider more “fuzzy” measures of maternal, child and family well being.

momofone

So should we all forego washing machines and bang our clothes with a rock beside a river, since that’s how our elders, with all their ancient knowledge and wisdom, did it?

My tiny great-grandmother (now deceased) would kick his ass for suggesting such a thing. Bubbe rather liked all the labor-saving devices that modern life came up with.

Who?

‘was’ being the operative word.

I don’t think you’ll find too many people lining up to soak in the tea-tree lakes in labour. And you would not want a baby dropping in there anyway, if only because it can be diffficult to see the bottom.

Though the lakes and surrounds are beautiful, and the water is pleasant.

“Historically Lake Ainsworth was an Aboriginal women’s water hole. It was sacred to indigenous women as a birthing place. Tea tree has wonderful antiseptic qualities so the women were said to birth and wash in the tea tree infused water.”

kilda

yes, I’m sure the Australian indigenous people, living in one of the harshest, driest places on earth, were ALL about the waterbirth.

Because when there’s only one source of water for miles to keep you and your whole group alive, squirting out poop, blood and a baby into it is an excellent idea.

momofone

And plagiarize their “work.”

Jacob Bunton

Well done you did some research. Maybe you can now explore a little further…

momofone

You didn’t “do research.” You read something you agreed with and stole the words of someone else and claimed them as your own. You have no credibility.

AnnaPDE

Geez Jacob, have you ever been to Australia? Do you realise that indigenous Australians are reasonable people who like their babies to survive, and not just objects for romantic projections? Please stop spreading such myths.

Most large-ish bodies of water around here are not where you want to give birth; in fact you think twice about wading or swimming in them. Crocs, sharks, jellyfish… take your pick of what you want to get killed by.
As for in tea-tree lakes — my in-laws live next to one of the more famous ones, and I had one swim in it. Excellent itchy rash developed within minutes and stayed for days. Plus, the water is incredibly murky, definitely not where I’d want to be fishing for a newborn.

MaineJen

………full wingnut. We have full wingnut.

Azuran

You do know there is a ‘recent comment’ section on the home page, right?

XD seriously? You think we are closer to sea mammals???
I mean, screw genetics, not a real science I guess

Funny how we suck so much at actually knowing how to swim. And babies, I mean, just look at a baby, We’d need to hold their face out of water for months, if not years before they could figure out how to not drowns. And that’s without taking into account how we can’t sleep in water, and how we need HUGE amounts of sleep. And we are absolutely horrible at keeping ourselves warm in water, we die of hypothermia really quickly in water. I mean, come on, you even said that it was really really important to keep the water at a warm 37-38 degree for the birth. Where on earth is water consistently that warm? We are not freaking sea mammals, babies are not meant to be born in water.

Heidi

*****Don’t you mean we’d go “dolphin-shit”?*****

Nick Sanders

The only “sea mammals” without extremely thick coats of hair are cetaceans and sirenia, which spend their entire lives underwater. Meanwhile, far more aquatic mammals are covered in dense hair: otters, most pinnipeds, beavers, platypuses, etc. I can also think of a fair number of land mammals with less hair than humans: elephants, rhinoceroses, naked mole rats, pigs…

And raw brain mass is meaningless, hell, brain to body mass ratio isn’t even that good of an indicator. Brain structure is far more important.

Long story short, the aquatic ape hypothesis is bullshit.

momofone

I figure I’ll be ready to give birth in the water around the same time the dolphins start using the internet.

Heidi

I know you’re not the smartest dolphin in the ocean, but there’s a place where you can sort the comment order by best, oldest, or newest – it’s under the place where you get notifications. I’m guessing you’ve got it sorted by best and that’s why yours are all the way at the bottom. Geez.

Amy Tuteur, MD

All that bullshit isn’t going to divert anyone from the fact that primates don’t give birth in water and therefore THERE IS NOTHING NATURAL ABOUT WATERBIRTH. Thanks for showing that you have no evidence otherwise.

I’m curious as to whether you have any insight into the fact that you’ve been repeatedly shown to be wrong and yet cling to the nonsense you were taught. Care to explain?

Jacob Bunton

“All that Bullshit… ”
Nice.
Well moving on then.
95% of the world thought the world was flat once….

Who?

So-‘ape shit’ uttered by you is fine, but ‘bullshit’ utttered by Dr T is a problem?

Tone trolling becomes you though.

Roadstergal

You are just as ignorant of history as you are of biology. Flat-earth-ism has been a fringe belief since science was a thing. The ancient Greeks not only knew the earth was roughly spherical, they calculated its circumference to a high degree of accuracy.

The scientific method works. You should try it sometime.

Jacob Bunton

So should you.

Roadstergal

“I know you are, but what am I” – when you’re digging for grade-school rejoinders, many people would take that as a sign they’re out of legitimate responses and should re-think their position. Not Jacob Bunton! He’s a MGTOW!

Azuran

Yes, all that bullshit.
This is nothing more than cherry picking. You decided that humans where somehow closer to Dolphin and then proceeded to name ways that they are similar, while ignoring the much longer list of how they differ, and the much longer list of how we are more similar to other primates. You also apparently decided that genetic is not a thing.
Here are some things to add to your list of random things we have in common with random animals:
-Parrots can say words
-Cockatiels can become bald
-Guinea pigs need vitamin c in their food or they get scurvy.
-Chinese crested dog are hairless, but they have hair on their head.
-A cow’s gestation is 9 months. they also have a cycle every month.
-Bears can stand on their back leg.
All of this means about as much as your stupid list.
And just because some people thought the earth was flat doesn’t give your stupid ‘hypothesis’ any credibility.

Lilly de Lure

Oh goody – we can add history to the ilst ofthings you know nothing about.

BWAHAHAHAHAHAHAHAHAHAHAHAHAHA!
So, tell me, does the Bimini Road lead to Atlantis or Mu? What’s Aquaman up to these days? Have the Deep Ones left R’lyeh and is Cthulhu still on the throne there?
For the love of all that is holy, do you even HEAR yourself?
BWAHAHAHAHAHAHAHAHHAHAHAHAHAHAHA!!!!!!!

kilda

does this have something to do with SpongeBob?

moto_librarian

Do gorillas or other higher order primates get in water to deliver? Because until that happens, claiming that humans should do it because dolphins is the most idiotic argument that I’ve ever heard.

Linden

All your bullshit analogies are nothing compared to the findings that, in the real world, water births injure and kill babies. You haven’t addressed any of the links that have been posted. Which leads me to think you are completely enamoured with your own theories, and don’t care a jot about women and babies and what keeps them safe.

Lilly de Lure

My previous post seems to have been eaten by disqus – basically even IF the aquatic Ape theory had merit (which it doesn’t) how does this help justify waterbirth for humans? If you look at how sea mammals give birth you will note that all of those species capable of doing so climb on to land to give birth. Whales and dolphins birth in water only because they can’t beach themselves without dying. Even Elaine Morgan never claimed we went as far along the aquatic route as that!

Do you not find it peculiar that you are advocating as safe and natural a path that evolution never leads a species down until it literally has no other option.

Roadstergal

Even dolphins get their newborns up to the surface to breathe right away.

Lilly de Lure

Good point – they are also born predominantly breech (as were ichthyosaurs so it’s almost certainly an adaptation to marine life rather than an individual quirk) to minimise the risk of drowning. So basically, left to itself evolution does not agree that face first birth is safe because of the diving reflex – dolphins have a much better one of them than we do and evolution still takes steps to ensure that it is not needed during birth!

Daleth

So, Jacob, thank you for sharing your views on the profound similarities between humans and dolphins, but I think you may be missing a subtle nuance here:

Specifically, the reason that dolphins give birth in water is because they live in the ocean.

We don’t live in the ocean.

Let me know if you want a cite for that or if you’re willing to agree that a key difference between dolphins and humans is that dolphins live in the ocean and humans live on land.

Jacob Bunton

Evolutionary perspective – it was related to a different post.

Daleth

If you want “evolutionary perspective,” consider that humans evolved by coming OUT OF the ocean and starting to live on land. There is nothing evolutionary about giving birth in a kiddie pool just because marine mammals similar to our remote ancestors live, give birth and die in the ocean.

yugaya

Mind the goalposts. Your previous claim: babies cannot drown during waterbirth. Those dead babies that drowned during waterbirths, that you have just buried twice with that statement, really have nothing to do with women getting epidurals.

Btw I’m starting to get nauseated by your obvious hatred of epidurals, adequate and safe pain relief for women in childbirth and the way you are inserting that obvious hatred into every avenue of this conversation.

Dr Kitty

Or…
You stop promoting and offering dangerous things no-one has the skills to oversee in hospital any longer.

Battlefield surgeons used to be able to amputate a limb in under 3 minutes- before the advent of anaesthesia and antisepsis.

That skill has been lost, and no-one offers speed lower limb amputations any more. So sad, all those lost skills.

Heidi

Yeah, I’m really upset modern day barbers no longer perform dental work and surgery! That’s why you won’t catch me going to an actual surgeon should I require any. I’m gonna hit up the lady who cuts my husband’s hair and let her gain her skills on me.

Nick Sanders

I love this, you complain about interventions, use the term “overmedicalization”, while in the same breath talking about waterbirth as if it were some normal, natural thing that’s been going on forever and not knowing how to perform this particular piece of performance art as a “loss of skill” somehow.

I recommend you compare death rates of babies born under modern medical conditions versus babies born without medical intervention. A baby born in the US has much better odds than a baby born in rural Somalia, Afghanistan, or Peru. Hell, a baby born in a hospital in the US has much better odds than a baby born at home in the US. “Overmedicalisation” of birth saves lives; there are no number of midwifery skills that can fix a transverse lie, pneumonia caused by meconium aspiration, or truly stuck shoulder dystocia. Only modern medicine can handle that.

You know how we know how many babies women had in the past? We read their wills. Every time they got pregnant, they updated their will because they were likely to die. A lot of cultures don’t name babies until they’re a week, a month, or even a year old, because babies died that often. They didn’t want to get too attached in case the baby died. Again, only modern medicine fixed this. You’re suggesting we give up the one set of tools that has seen a massive increase in babies and mothers living instead of dying, because … why are you suggesting that, anyways? I’m still not sure. Something about natural, as if nature is a kind fluffy bunny instead of ‘red in tooth and claw’. As if everything we do as humans isn’t natural- we are tool users, so let us use our tools!

Jacob Bunton

Someday the majority of women will not give birth in hospitals because they will realise that childbirth is not a disease.

IF they have a disease for example, pre-eclampsia, cardiac, respiratory, liver disease other medical conditions etc..they will go to the hospital.

Why is it America has some of the worst birth statistics in the modern world?
Homebirth accounts for only 1% of birth so it cannot be due to that, can it?

The Farm, Ina May Gaskin, has the best birth statistics for a midwife unit in the world. See spiritual midwifery text appendix

What is happening in America? It doesn’t make sense? It has all the latest technology, spends more on healthcare than any other country, has machines that go bing and medics knocking on doors , ‘just saying hi..in case I need to rescue you from an emergency in 5 hours time.’

Roadstergal

Someday?

Oh, you myopic little man. Women have been birthing outside of the hospital for most of recorded history. Women birth outside of the hospital in many places in the current day.

Tell me, what is the perinatal mortality for birthing in vs out of hospital, in comparable risk groups?

If you need a hint, Edith Rooks did a study on planned home vs hospital birth in Oregon, where the homebirth midwives are totally up your hands-off naturalistic fallacy waterbirth alley.

Azuran

Childbirth has been the number one cause of death of young women for the entire human history. That changed with hospital birth. So no, you won’t be convincing the majority of us that it’s safe. Homebirth might be only 1%, but it already has a higher death rate so more homebirth means more deaths.

As for why the USA has a higher death rate: They have, BY FAR the shittiest health care system out there. especially for women. Right now, they are still trying to make abortion illegal. They want to give companies the right to refuse to cover contraception. They are arguing that men shouldn’t contribute to paying prenatal care, they want to make pregnancy a pre-existing condition. And they don’t have paid maternity or parental leave.

Amazed

The Farm. The Farm. Hahaha! The best statistics for a midwife unit? Perhaps. Self-reported, never viewed by an outside researcher because Ina May Let My Own Premature Baby Die Gaskin won’t allow it? Who cares!

Was Ina May’s own, intentionally left without medical care baby in these stats?

Charybdis

Stop. Just stop. Ina May Gaskin supports and encourages sexual abuse in her patients/clients. She is an abomination and is certainly NOT a person one should admire and emulate.

Jacob Bunton

WTF

Heidi

“It helps the mother to relax around her puss if you massage her there using a liberal amount of baby oil to lubricate the skin. Sometimes touching her very gently on or around her button (clitoris) will enable her to relax even more. I keep both hands there and busy all the time while crowning … doing whatever seems most necessary.”

“Sometimes I see that a husband is afraid to touch his wife’s tits because of the midwife’s presence, so I touch them, get in there and squeeze them, talk about how nice they are, and make him welcome.”

-both IMG

And I’m about to throw up now.

Jacob Bunton

Oxytocin – yes could have been worded differently I agree but I’m guessing she talking about release of oxytocin….. I understand your repulsion but I also get it. The sexual element of birth confronts you? Sheila Kitzinger book ‘Birth and Sex’ explains it

Heidi

Sexual assault – let’s be clear what that is. Yes, the idea of being sexually assaulted by my nurse or doctor sickens me. It really doesn’t matter how it was worded. This is IMG admitting to sexually assaulting women.

IF YOU TOUCH SOMEONE’S SEXUAL ORGANS WITHOUT CONSENT IT IS SEXUAL ASSAULT! It cannot be more clear than that. IMG is therefore blatantly admitting to sexual assault on her patients, because she openly admits she does not ask for consent before doing any of that.

If a woman finds birth to be sexual, fine, more power to her. If a midwife sexually assaults someone during birth, there is no word for how not-fine that is.

Charybdis

You know what else is good for getting oxytocin into the system?
Pitocin. No fondling, rubbing, tweaking, twiddling, massaging, etc. necessary. And you can regulate the dosage.
Yes, there is a sexual element to childbirth; aspiring for it to be the most orgasmic experience of your life is just false advertising. You orgasmed during the birth of your child, or you found it an overwhelmingly sexual experience? Good for you. Not everyone will find it so and there is nothing wrong with that. Expecting everyone else to have that same experience is also wrong.

Azuran

So, you think that it would be ok for OBs and nurses to start asking labouring women if they want him/her to masturbate them or fondle their breasts to help them with labour? You really think that such a thing is EVER appropriate for a health care provider?

Don’t let the head
suddenly explode from the mother’s puss. Coach the mother about how much and
how hard to push. Support the mother’s taint with your hand during rushes. It
helps the mother to relax around her puss if you massage her there using a
liberal amount of baby oil to lubricate the skin. Sometimes touching her very
gently on or around her button (clitoris) will enable her to relax even more. I
keep both hands there and busy all the time while crowning … doing whatever
seems most necessary.

And:

Sometimes I see that a
husband is afraid to touch his wife’s tits because of the midwife’s presence,
so I touch them, get in there and squeeze them, talk about how nice they are,
and make him welcome.

And:

I might want to have a
cunt one day and a twat the next. On the third day I might decide that pussy is
my favorite word.

This is someone midwives need to emulate? Seriously?
WTAF is wrong with you?

Sarah

I feel dirty reading that. Not in the good way.

Azuran

Each time I read this, I start feeling deeply tainted.

Heidi

I feel just as disgusted reading it as I have when older men when I was a teenager and in my early twenties would say sexually explicit stuff to me. Now that I’m older, I think those vulgar, creepy men know, women my age generally have enough confidence and experience not to put up with that shit. But then you can expect some creepy midwife to pounce upon you when your pain is so bad, you aren’t even sure what’s going on.

Sarah

No pun intended?

MaineJen

FFS. Do you remember what the maternal and perinatal mortality rates were back when most women didn’t give birth in hospitals? They were abysmal. You want to go back to that?

You know what else isn’t a disease? A broken leg. A heart attack or stroke. A gunshot wound. None of those are diseases. You think that hospitals only exist to treat disease?

Azuran

How could the ‘skill’ of water birth be lost? It’s not at all an ancient practice, it’s just a fringe midwife practice without any basic in actual medicine. In order to lose a skill, it first has to be one, and waterbirth isn’t.
And really, putting asside the fact that waterbirth doesn’t actually require any particular skill (you really don’t need that much skill to assist an uncomplicated vaginal birth, and if there are complication, they get out of the pool so it’s not a water birth) who cares if the skill set required to do something dangerous is not maintained.
I find it funny that you seriously think that OBs lack the skill to do waterbirth. They just don’t want to because it’s not a medically recommended practice.

Jacob Bunton

Birth is an involuntary act.
What else is an involuntary act?
Is it medically recommended practice to watch how a person urinates?
Sometimes it is and sometimes it isn’t.

Charybdis

Oh, I think there are several voluntary acts that precede a birth and some of those are more deliberate than others (IVF comes to mind). The ‘how’ of birth is voluntary (vaginal, cs, medicated, unmedicated, choice of medication for pain relief, etc).
I think you were maybe looking for the word “inevitable”. Because once you are pregnant, there are only two ways to get the baby out: CS and vaginally. There are modifiers under those choices, but there are only two ways to deliver a baby.

Roadstergal

“Why aren’t babies drowning in utero?”

Because they’re in the mom and the placenta is firmly attached to mom. As long as it is, oxygenated blood is passed to the baby. As soon as the baby is delivered, the placenta detaches and the baby no longer gets oxygenated blood from mom, and needs to breathe air.

Sometimes, the placenta can fail when the baby is still in utero, which starves the baby of oxygen even in utero. So yes, the baby can die of lack of oxygen in utero.

It’s a sad state of affairs that you’re allowed within 30 meters of a pregnant woman.

Aine

“yes its easy to forget that the baby during pregnancy is actually in a sack of water.”

Are you deranged?? If any of my care providers FORGOT that my baby was in a sack of amniotic fluid (not water), I’d want them disciplined, possibly struck off. Are you admitting you often forget basic biology? What else do you regularly and easily forget?

Jacob Bunton

This was not directed at you, of course care providers don’t forget this, but in clinic I get asked sometimes when baby born in water how does it breathe. Often the mothers remind their partners, ‘the baby is in water now silly’ and the partner laughs sheepishly and says ‘oh yeah, I forgot’. Yugaya comments seemed to reflect this, that’s all.

Nick Sanders

How does it breathe? It doesn’t. The lungs pump and all, but no respiration takes place, the baby instead getting it’s oxygen from the mother’s blood. Once the baby is outside the mother, this is no longer possible, for what I would have assumed to be obvious reasons until I read your drivel.

Jacob Bunton

I was about to say well said Nick. Until I unfortunately read your last sentence.

Roadstergal

Do you really think amniotic fluid is just water?

Amy Tuteur, MD

Perhaps you have forgotten or never knew that the baby breathes in amniotic fluid in utero. If you are so ignorant of basic neonatal physiology you should not be allowed to care for anyone.

You are simply regurgitating the nonsense that you have been taught. It has no basis in science.

Jacob Bunton

We’ve covered this Amy move on

Amy Tuteur, MD

We’ve covered the fact that you are ignorant of basic neonatal physiology?

Heidi_storage

Well, to be fair, yes, he has covered that over and over again, whether he realizes that or not.

Jacob Bunton

Am I?

Roadstergal

You sure are, Mr “babies breathe water in utero” Bunton.

Nick Sanders

She posted that before you posted your bullshit “covering”. Are you really so dumb you can’t read a timestamp?

momofone

“I don’t have an adequate response to this so stop pressing me about it.”

“Although it has been claimed that neonates delivered into the water do not breathe, gasp, or swallow water because of the protective “diving reflex,” studies in experimental animals and a vast body of literature from meconium aspiration syndrome demonstrate that, in compromised fetuses and neonates, the diving reflex is overridden, whichleads potentially to gasping and aspiration of the surrounding fluid.”

Jacob Bunton

Yes correct. In COMPROMISED fetuses. This means babies may breathe in meconium for example while in the womb. This can happen and does happen on dry land with epidural. Yes this can happen in pool, so that why the fetal heart is auscultated, the waters once they break are checked to be clear, if there is thick mec or the FHR is non-reassuring then the woman is asked to leave the pool.

Even if your deranged ramblings held a grain of truth which they dont, then how, pray tell, do midwives, with all their superhuman knowledge you rave about in your gushing praise, happen to witness the birth of COMPROMISED fetuses?

Midwife knows this… Midwife knows that… Midwife knows all… Ah, a tiny little speck midwife doesn’t know: baby is compromised, that’s why the baby dies. But don’t worry, baby was compromised anyway, nothing to see here, move on, move on! Oh and don’t forget to bring all the medical staff to witness the waterbirhs of all those umcompromised fetuses, so they can appreciate the beauty of waterbirth and not bitch about silly little things like preventable deaths.

I had forgotten about her. I was happy having forgotten about her. And yes, now that you’ve reminded me, the resemblance is there.

My favourite part is their genuine, IMO, trust that what they write is so powerful that it will magically convert us all right upin the spot, so Dr Amy just HAS to delete it.

maidmarian555

I am 99.9% certain that Anna Perch was also a man.

mabelcruet

My apologies-I should have flagged the post with a trigger warning!

Linden

So these “compromised” fetuses must die?
Seriously? You don’t think there is anything wrong with prioritizing a waterbirth above the well-being of a baby?

Roadstergal

I think his argument is that modern obstetrics has lost the art of sitting around and doing nothing during the natural process of waterbirth, and that has infected the wootastic midwives who do waterbirth, which ends up with the fetus being compromised, which wouldn’t have happened if they had done more of nothing…?

I’ll be honest, it’s tough to parse out.

Azuran

And how do you even know that birthing in water is more ‘gentle’ to the baby?
Why do you even think that babies need gentler birth?

Heidi

Gentle is not the word that comes to mind when I think of vaginal birth – neither for mother or baby, regardless of land or water. I’m pretty grateful I can’t recollect my birth at all. Actually, I’m pretty grateful I can’t remember being stuck like a canned whole chicken in my mother’s womb.

The Bofa on the Sofa

Hey, when I see babies come through vaginal birth with come heads, I think, “Oh, that must have been gentle.”

Not.

Jacob Bunton

Why do you think babies may need a gentler birth?

Azuran

I don’t think that they do. You do.
And if they actually did, a c-section would me much better than a waterbirth.

Jacob Bunton

And contribute to the already sky rocketing obesity rates and type 1 diabetes…

momofone

Sources? (Credible ones. Thanks!)

Roadstergal

Yes, because it’s well-known that C-sections cause obesity and diabetes, rather than obesity and diabetes making it more difficult to successfully deliver vaginally and requiring more C-sections to allow women with genetics for same to successfully pass it on to their children with minimal damage.

I mean, T1D having a genetic component? Who ever heard of such a thing.

Similarly, the sun coming up in the morning generates my urine. How else can we explain my need to piss when it rises?

Jacob Bunton

Primal Health Research Database

Azuran

HAHAHAHAHAHAHAHAHAHAHA

Wait, you are serious?

HAHAHAHAHAHAHAHAHAHAHA

yugaya

Like I said, he is as fucked up psycho about waterbirth as Charkovsky is.

Jacob Bunton

Perinatal origin of adult self destructive behavior

Birth record data were gathered for 412 forensic cases comprising suicide victims, alcoholics, and drug addicts born in Stockholm after 1940 and who died there in 1978 – 1984. Comparison with 2901 controls. Suicides involving asphyxiation were closely associated with asphyxiation at birth; suicides by violent mechanical means were associated with mechanical birth trauma; drug addiction was associated with opiate or barbiturate administration to mothers during labor.

What was that?
You still laughing….me too
Hahahaha yeah what’s the point in researching about what happens to us at the most critical time of our human development?
hahahaahhaaa
Who’d think of such a crazy thing?
What a waste of time?
Now who’s up for a beer?

Nick Sanders

Only 412 people over 6 years? That reeks of cherry-picking to me.

Roadstergal

I’m trying to read the paper, but anything past the first page is $38 to access (because my institution only allows access to reputable journals). Screw that, a decent David Eddings book is $5 and is more entertaining fiction.

Charybdis

No, no, no, Nick. That is the case load of a “very busy” midwife or two. And because it is from midwives, everything they say is the gospel truth.

Nick Sanders

I know you are snarking, but this isn’t even midwives, it’s suicide statistics. I don’t know how many people killed themselves in Sweden during those six years, but I’d bet dollars to donuts that it’s enough that you could get nearly any kind of correlation you wanted if you limited your data to just 412 of them.

Azuran

Yes, I’m still laughing. Actually, I’m laughing even more.
and no, the few hours of birth are definitely NOT the most important of our developments.

Also, you might want to check if those who are born in water are more likely to kill themselves by drowning.

Roadstergal

Oh, now that is an excellent point! If Jacob is right, that definitely follows. I was born on dry land, and I have no water phobia from early uncontrolled immersion – I’m a very good swimmer. These things are certainly causally connected.

Azuran

I also wasn’t born in water, and I’m a good swimmer and I love water.
Same goes for my sister, who could swim before she could walk.
My baby wasn’t born in water either, and so far she loves taking baths
So now we have N=4. So it’s definite proof.

Azuran

And seriously, one study from 30 years ago has absolutely 0 scientific value.
Reproducibility and repeatability are what is truly important when following the scientific method.

Heidi_storage

Honestly, this sounds a lot more like early 20th century psychoanalytic stuff than an actual, meaningful correlation.

Actually, the contractions themselves can stimulate breathing- not always, but sometimes. And then those babies are breathing water, blood, and feces all at once. Yay!

Jacob Bunton

Evidence?

Who?

Well, there’s water, with blood, faeces, maybe urine and who knows what all else, and a baby fully submerged.

Come to that, even if the baby is pulled out before its first breath, it seems gross. Eye infections, ear infections. Yuck.

Roadstergal

I posted links to actual case studies of babies actually dying of material inhaled during waterbirth. During those magic spontaneous hands-off VDs. The BMJ had a 1999 study that tried to do the Birthplace brush-off of dead and damaged babies in the abstract, but if you read the whole article, they have a 1.2/1000 perinatal mortality in this set of very low-risk pregnancies, and a high NICU admission rate for breathing/drowning/infection issues. “Of the 32 survivors, 13 required respiratory support (ventilation or continuous positive airways pressure or head-box oxygen) Fifteen of the survivors had lower respiratory tract problems, variously labelled as pneumonia, transient tachypnoea of the newborn, or “wet lung”; suspected aspiration; meconium aspiration; water aspiration; and “freshwater drowning” (1, who had hyponatraemia)).” Five of the babies had a snapped umbilical cord, because you can’t exactly manage that well in a waterbirth.

But they’re probably just ‘compromised’ somehow, anyway. In Jacob Bunton’s world, either everything goes right, or the baby was somehow ‘compromised’ and meh, fuck ’em.

Evidence that babies have died due to breathing in water as well as all sorts of other deadly stuff while waterbirthing has been posted for days. You haven’t addressed any.

Here’s more: 2012 death of a baby born completely healthy in Canada that succumbed to bacterial sepsis 36 hours later which was attributed to home
waterbirth: ” . It was inferred that the endotoxin-producing bacteria reached the alveoli during the birthing process with a possible source being the bath water in which the woman was immersed during labour. The cause of death was “perinatal infection by endotoxin-producing bacteria.” Recommendation that was made based on review of full autopsy report:
” The Canadian Pediatric Surveillance Program (CPSP) initiative collecting data on early onset neonatal sepsis should consider adding information regarding maternal use of water immersion during labour and delivery.”

“infant who developed severe pneumonia and disseminated adenoviral infection following water
birth delivery to a mother with gastroenteritis. The infant’s infection was due to an adenovirus strain
that has not been previously reported in neonates .In the present case,the neonate’s HAdV infection likely occurred by vertical transmission during the water birth since the mother had symptoms of gastroenteritis with defecation into the water bath immediately prior to delivery. She died shortly after being taken off ECMO (19 days of age).” http://onlinelibrary.wiley.com/doi/10.1002/jmv.23517/pdf

There is also one maternal death recorded in UK that was associated with infection acquired during waterbirth (CEMACH report), but Jacob should be able to tell us more about that since he is the one peddling waterbirth as safe in UK.

Roadstergal

Do you think a ‘gentle’ birth is important?

If so, you definitely support MRCS, yes? What could be more gentle than being carefully lifted from the womb, with no juicer-style squeezing through an opening so small the baby’s skull bones have to shift and mould to make it out?

EmbraceYourInnerCrone

True! My brother was my mom’s only C-section baby, she said that unlike me and my sister the cone-heads, my brother had a beautiful round head and no squishing of his face.

Charybdis

Yes, the umbilical cord keeps the baby alive IN UTERO, along with the placenta. What do you do during a waterbirth if say, the cord is short, too short to allow the baby to fully descend or to be expelled from the vagina? How about knotted cords? Nuchal cords? Prolapsed and/or compressed cords?
How about failing placentas? Old ones with calcifications or small ones? Abrupted or partially abrupted ones? How do you address those whilst in the midst of a waterbirth? Or do you just ignore these potential issues because to speak or even think of them will introduce negativity and suddenly make that very thing manifest?
Seriously. You have not satisfactorily answered anyone’s questions. Still waiting….

EmbraceYourInnerCrone

The baby is kept alive by the Placenta being still attached to the uterine wall, being attached to the umbilical cord itself isn’t going to help if the placenta is starting to detach or has detached.
My daughter started breathing during labor, she also passed her first bowel movement and aspirated it. So where is your evidence that ” baby will not breathe under water”

Jacob Bunton

I think yugaya you are posting on the wrong site. WTF

yugaya

Really? Explain to me what is natural or physiological about waterbirth. I’ll wait. I’ve explained in great detail why it is a lunacy invented by a psychopath who hated women.

Cochrane review did not include perinatal mortality as measure of outcome. When you exclude the dead babies, waterbirth indeed sounds like a harmless idea.

Jacob Bunton

What are you guys looking at? Check your source. RCOG. NICE guidelines. Cochrane Review. The Lancet. British Medical Journal. Primal Health Research Database. Are good sources to start with.

yugaya

I checked RCOG guidelines and they didn’t have any of that hands off breech you claimed was in them. I also checked the link you posted for that midwife knowz crap you posted but it didn’t have any of that lotus birth leave cord uncut until placenta delivers crap either. As opposed to that gaslighting of yours, you will find all the content I am quoting on the links posted, showing how that waterbirth you are selling is a lunacy invented by a bloody psychopath who openly hated women and knowingly killed babies during his waterbirth experiments:

” *He was not that into women*. Or babies: ” I think everything was OK in the very beginning, until he crossed a certain line. There is a certain boundary, you know. He crossed it. He stopped regarding babies as a self-consistent value; he made them a mere material for his experiments. He did not care anymore whether the baby survives… You shouldn’t make anyone your guru. Nobody forced the parents to give him their babies [for water trainings]. They gave him their babies without any doubts. I don’t know if they really had no doubts, however they did nothing to get their babies back
from him. Another homebirth midwife, interviewed in a film about waterbirth, seconds this opinion:
Reporter: Yulia considers Charkovsky to be an immoral person. In her opinion, he regards pregnant women and babies just as a material for his experiments, some of which are really dangerous for their lives. Yulia Postnova [homebirth midwife]: Probably he understands this deep inside himself,
but he still tries, he goes on with his experiments. That’s what I call crime.”

Yes I’ve seen an “uncomplicated” waterbirth- colour me unimpressed. I can’t see any benefits at all.

The only people, BTW, who don’t like junior doctors sitting in on normal low risk deliveries are midwives. Women and senior obstetricians are quite happy to “allow” it, midwives, not so much. I used to introduce myself to every single woman on delivery suite when my shift started, and pop in and out of the delivery rooms throughout the shift, because I didn’t want to be a stranger in case of an emergency. The women were quite happy- the midwives not so much.

I’ve also seen a massive PPH and a bad shoulder dystocia after unmedicated, midwife supervised waterbirths, but of course I only arrived in the room after all the magical sparkles had already left.

Jacob Bunton

Dr Kitty I’m glad you had the opportunity to attend a waterbirth during your training, many have not had or been given that opportunity. I personally feel ALL birth attendants MUST see waterbirths, unmedicated births as well as medicated births and ELCS and EMCS. Otherwise you become skewed either way.

Dr Kitty

As I said. Saw it.
Not impressed.

Thought that women looked happier and more comfortable birthing on land, with epidurals.

And babies certainly looked pinker and had higher APGARS when they weren’t delivered in water.

Jacob Bunton

First comment – true you entitled to your opinion.
Second comment – its the woman/women who will tell you if she is happier not for you to presume or assume how she is feeling.
Third comment – yes physiological birth doesn’t always ‘look’ comfortable
Fourth comment – I need to clear something up which has been bugging me. I saw an earlier comment, I did not scream, bite etc, my epidural nicely in place. I was with a woman while I was training with epidural in situ and she was pushing, she said to me and the midwife, ‘I can scream if you like, that’s what they do in the movies.’ I asked her if she could feel anything. She said, ‘no’. FACT most women with a fully working epidural don’t scream, they are not in pain and appear comfortable. Ok, glad we cleared that up.
Fifth comment – pinker true, poorer apgars in water NOT true. The last birth I attended was the usual 9 at 1 min, 10 at 5 mins, 10 at 10 mins.

MaineJen

Hi, Jacob. I am an actual woman who has given actual birth. I had a “functioning epidural” both times, and it’s true, I wasn’t in pain while pushing. Is that a bad thing? I was very happy with how things went both times: short second stage, minimal damage, healthy baby.

You don’t seem as interested in listening to actual women (at least, not in listening to the ones who disagree with you) as you are in advocating for unmedicated water birth.

Are you an inflatable tub salesman on the side?

Heidi_storage

Training for what? What are you, and why are you allowed near laboring women?

Roadstergal

“women with a fully working epidural don’t scream, they are not in pain and appear comfortable.”

Only in Jacob Buton’s world is this a _bad_ thing.

Dr Kitty

Because to Jacob women should be making guttural noises, incoherent from pain, having their neo-cortexes fully stimulated. It might appear to be agonising pain to a casual observer, but it’s labour, and natural, and really much better for women.

Women laughing, joking, knitting, drinking tea, sleeping and watching Neflix during labour because they have working epidurals and no pain are doing it wrong, missing out on something vital and damaging their babies.

Did I miss anything?

Jacob Bunton

Yes. You missed the part about Choice. I find it ironic that the only people telling women HOW to birth and NOT birth is you guys!! ???

Jacob Bunton

I SUPPORT women WITH and WITHOUT an EPIDURAL.

BTW Dr Kitty just a small important correction in ref to your above post of the woman.. ‘having their neocortex NOT fully stimulated’ is key.

momofone

You still somehow managed not to address the MRCS/RCS question.

Roadstergal

Then why have you been dodging Dr Kitty’s straightforward MRCS/RCS questions – an actual woman discussing her actual birth choice – for three days, while yammering up and down the thread on either side?

Jacob Bunton

I thought I covered MRCS question – I assume this means Maternal Request for c-section. Here it is called ELCS via maternal request.
RCS?
We don’t use that term.

Mattie

RCS is repeat section I assume, I don’t ‘know’ but it’s pretty easy to understand in context anyway.

momofone

Here elective c-section is medically necessary but not emergent, so it is planned. Maternal request means not medically necessary but done due to mother’s wishes. RCS is repeat c-section.

Charybdis

We don’t give a damn what terms you use. MRCS is a maternal request C-section, also called an elective C-section. “Elective” does not mean “unnecessary”, it means “scheduled” or “non-emergent”.
So, now that that is cleared up, how about answering the questions about maternal request C-sections?

Daleth

RCS means repeat c-section. In other words, giving birth via c-section after having already given birth to one or more previous children via c-section.

Jacob Bunton

Ok thank you.
Yes RCS whats the problem? Fine. If a woman wants that, that is ok.
It is recommended RCS after 2 or more C-section but if she wants one after a previous first, that’s ok.
Some women ask for a VBAC vaginal birth after c-section.
Hospital labour ward setting is recommended due to risk of scar rupture, and continuous electronic fetal monitoring (CEFM) also recommended.
If woman wants VBAC, ok if not OK, if wants RCS ok?
Sorry don’t understand the problem.

Azuran

Oh but we totally agree that a woman has the right to water birth. What we don’t agree on is that hospitals have an obligation to allow and enable women to birth however they want on their birth ward.
Some choices are just stupid, you can chose them, but they are still stupid, others have the right to call them out on their stupidity and don’t have the obligation to help you do stupid things.

Jacob Bunton

Dr. Amy posted a link from AAP….”Facilities that plan to offer immersion in the first stage of labor need to establish rigorous protocols for candidate selection, maintenance and cleaning of tubs and immersion pools, infection control procedures, monitoring of mothers and fetuses at appropriate intervals while immersed, and immediately and safely moving women out of the tubs if maternal or fetal concerns develop.”

I am glad to say that hospitals offering waterbirth follow these protocols.

The abstract also states btw “Immersion in water has been suggested as a beneficial alternative for labor, delivery, or both and over the past decades has gained popularity in many parts of the world. Immersion in water during the first stage of labor may be associated with decreased pain or use of anesthesia and decreased duration of labor.”

Thank you Dr Amy for the reference.

Roadstergal

You do know the difference between ‘immersion in the first stage of labor’ and ‘waterbirth,’ don’t you?
Oh, wait, this is Jacob Bunton we’re dealing with, so probably not. I’ll offer a summary in small words – the AAP and the ACOG do not support waterbirth as a safe practice (because it isn’t) that confers any benefits (because it doesn’t).

Who?

‘…suggested as beneficial…may be associated with…’

Compelling.

Charybdis

But nowhere does it state that the facility is REQUIRED BY LAW to offer waterbirth. It states that they CAN offer immersion in the first stage of labor, but they are under no edict to actually do so.

Roadstergal

The guidance he is quoting from actually recommends against waterbirth except in the context of a clinical trial. It’s only about immersion in early labor, and even at that, they’re very clear about maintaining high levels of hygiene, sufficient monitoring, and risking-out.

MaineJen

Well geez, every big hospital already does that. Some of the tubs even have jets, although the jets are not turned on if your water is already broken.

yugaya

Immersion in water during first stage of labour while adhering to rigorous protocols is NOT what you did – the patient in your care was contraindicated for a full on waterbirth that you enabled. It is also not that dolphin crap you are selling.

Jacob Bunton

Protocols were indeed followed at this hospital, according to the guidelines hb 98 and previous pph of 500ml, induction of labour with propess with 1 does only – eligible to birth in the Alongside midwife led unit, which is simply on labour ward but the rooms are designed differently and have a pool. It is not a question of care contraindicated but whether the care provider actually wants to provide care for that particular woman. Some have the relevant training and experience and others not as much, just like a junior doctor and consultant obstetrician. It is for the Consultant to teach the junior and vice versa, much learning is exchanged, the importance is care is safe and by a skilled professional with the relevant experience and knowledge.

yugaya

“Protocols were indeed followed at this hospital, according to the guidelines hb 98 and previous pph of 500ml,”

RCOG again: “Active management of the third stage of labour lowers maternal blood loss and reduces the risk of PPH.
Prophylactic oxytocics should be offered routinely in the management of the third stage of labour in all women as they reduce the risk of PPH by about 60%”.

I’m gonna discard all your guesstimates on the basis of how many women in UK die from PPH each year because their midwives waited too long or underestimated the severity of their PPH.

momofone

You seem to think “Choice” means having a waterbirth vs not having a waterbirth. I could not care less how someone else chooses to give birth (and frankly don’t understand why you do), but I care a lot about having some woo-based non-intervention foisted on women under the guise of giving them choice. If a woman wants to labor without pain relief, more power to her. If she wants to labor in a tub, so be it if it’s available. If she wants a pre-labor c-section, rock on. AMU/hospital/whatever/epidural/no epidural/Mongolian throat singing/what the fuck ever. The tub is not the point; choice encompasses much more than that.

Sarah

There is no way you could possibly think that’s true.

Roadstergal

It looks like we all missed the part where pushing on an undilated cervix is a great thing to be encouraged, as long as the woman doesn’t have an epidural.

Spamamander, pro fun ruiner

Silly me, getting that epidural after 14 hours of pain, waking up at 4am because my water broke, and desperately wanting a nap. Surely being comfortable was a horrible thing!

momofone

If you had only trusted your neo-cortex!

Jacob Bunton

Who said it was a bad thing?

Dr Kitty

Jacob,
I’m going to assume you’re female and using a male pseudonym.
Because I don’t really think that such a rarity as a male midwife would have actually posted all the potentially identifiable patient info you did.

How did your labours and deliveries go, when you had your own babies?

Just out of interest.

momofone

Clearly having seen a bit of all of the above has not kept your perspective from becoming “skewed.”

If you’re an OBGYN, you’ll see unmedicated, uncomplicated births as well as the ones that go wrong or the ones that are C-section (emergent or not). That’s because a lot of births are uncomplicated. We go to hospitals because there’s a chance something goes horribly wrong, and it’s best to be in a place with the equipment and professionals who can 1) figure out something’s wrong, 2) figure out what is going wrong, and 3) fix it.

Waterbirth is a whole nother kettle of fish, because it prevents steps 1, 2, and 3 above plus introduces additional chances for things to go wrong. It’s a stupid, risky choice and one that I wouldn’t blame hospitals for banning. They don’t actually have to provide all options, only medically indicated ones or ones with reasonable risk/reward outcomes. A waterbirth gone wrong presents a huge liability risk and absolutely no benefit whatsoever to anyone.

MaineJen

As you have become skewed in favor of unmedicated water births.

demodocus

lol, I had 3 students with my first, the ob’s resident, the student nurse, and the woman who my regular ob thinks must have been a more novice resident for a different doc. ETA, I saw ’em and basically thought eh, feck it. I’m busy.

MaineJen

Exactly. I had zero problem with any students being in there. They’ve got to learn some time, and I had bigger things to worry about at that point.

KeeperOfTheBooks

Yup. One of the things I actually liked most about my first kid’s birth was the excitement and joy that I saw in the anesthesiology student who had come to watch. It was her first day of clinicals (residency? Not sure what it’s called for anesthesia students), and my kid’s birth was the first she got to see as a student. I didn’t mind at all–figured she had to learn sometime–and I still smile when I remember her coming by the next day to check on us and thank me again. And hey, I got to help teach a student how to be a good anesthesiologist! Pretty cool, in my book.

Dr Kitty

Jacob- BTW, question for you, since you’ve dodged the ones on MRCS.

How many women have you cared for who have requested emergency repeat CS when they arrive in spontaneous labour after previous CS?

How fast did their CS happen, or did they all change their minds and decide to VBAC after you spent some time with them?

I had recurrent nightmares about going into labour before 39w with my second, and having midwives delay or deny my RCS, based on the attitude of several NHS midwives that my decision that under no circumstances did I want to attempt a VBAC, even if I arrived in active labour, was beneath contempt.

Nick Sanders

Who the fuck cares?

Jacob Bunton

Your perceptions may be skewed. Neither are safe. Balance is key.

Nick Sanders

No, accurate assessment is key. Objective analysis does not mean treating all things as equal, it means looking at the facts. And the facts show that even if standard hospital birth isn’t “safe”, it’s definitely safer than water birth or home birth.

yugaya

” How many obstetricians have seen a waterbirth?” Seeing is believing? Gross.

You were saying something about … skewed perceptions?

momofone

“Balance is key.”

That’s ironic. You are a one-man waterbirth public service ad.

Dr Kitty

Want to talk about what I actually raised?

That women don’t want what you think they want?

They want fast, safe, deliveries that are as painless as possible.
You aren’t giving them that.

You aren’t even giving them what you promise- a magical earth-shattering transcendent experience.

Sometimes midwives are giving women longer, more painful labours, more difficult deliveries, damaged and dead babies and a lifetime of health problems by refusing to intervene.

You still haven’t said one word about that.

MaineJen

Jacob Bunton is very concerned that your training may have been inadequate, Dr. Kitty.

Great god, the balls on this guy.

Amazed

Well, he’d like to know that after he’s done providing them with the care Dr Kitty described, they’d get a good doctor, I suppose.

Roadstergal

It reminds me of something I read on Facebook. “If I only had the confidence of a middle-class white man!”

Roadstergal

So, it’s been two days and you’re still posting above – but you haven’t had the time to ‘fully reply’ to Dr Kitty yet? Or answer any of her questions directly below?

moto_librarian

Yet you have plenty of time to post your rambling bullshit theories about birth. How interesting that you are incapable of engaging with those of us with the personal experience that invalidates your garbage.

kilda

yep. It’s the ever popular “I’m too busy/I have a life” gambit. “I’m too busy and important to respond to your arguments, but I totally have a really good answer to them. I’m just too busy to tell you it.”

Jacob Bunton

I’m engaging with you librarian. I’ve asked you questions as I have others. I am one you guys are many. I am on the ground floor you guys appear not. Maybe research your own answers, open a book, read a scientific paper, open your mind, be awake.

Amazed

You are not engaging with Dr Kitty, though. Why not?

Scientific paper? From the man who can only repeat midiwife nonsense until he reaches ecstasy? You’re so funny.

moto_librarian

You might want to look into time zones, Jacob. And this is indeed the first time that you have chosen to directly engage with me. I can assure you that I am quite capable of doing research as it happens to be my profession.

momofone

I’m curious–is there anything the midwife DOESN’T know?

Linden

She must be actively trained in the art of not shouting “push!” It sucks all the oxygen out of the room, and reduces cerebral oxygenation in the baby. Very important training, that.

Charybdis

Oh, and don’t forget to turn down the lights and reduce neocortical stimulation in the mother. Don’t talk to her and don’t, under any circumstances, touch or examine her because this is apparently VERY BAD.
/eyeroll

kilda

right. We can’t have ladies using their *brains* or their reproductive systems will stop working right because their poor little system just can’t handle it. How very Victorian.

Linden

It’s like this sexist shite never goes out of style.

yugaya

“A woman in spontaneous labour is quite predictable.”

I am so fucking glad that you weren’t my midwife for my “quite predictable” spontaneous second labour that went from 2cm to 4kg baby out in three contractions and in under five minutes. You would have probably still been too busy turning on the lights to see what is going on and/or sitting on your hands instead of actively managing a trainwreck into which my lovely spontaneous labour turned into in a matter of seconds. .

Platos_Redhaired_Stepchild

This is complete horse puckey.

Azuran

Piece of advice: If you have to AVOID stimulating a baby to breath, then you are doing something wrong.

Jacob Bunton

While the baby is underwater you would stimulate it to breathe?

Azuran

The point is that this baby should be born on land and should be stimulated to breathe.
The fact that you are voluntarily birthing a baby in a situation where BREATHING is dangerous should tip you off that you shouldn’t be doing so.

MaineJen

The baby should not be underwater. I would think that would be obvious.

Wow. So much bullshit to wade through, so little time. Suffice to say, being relaxed doesn’t automatically mean labor is going to go well, different positions work better for different women (since pelvises come in different shapes), pushing on not 10 cm can lead to seriously bad complications, midwives are notoriously bad at diagnosing 3rd and 4th degree tears and thus not getting women the care and repair they need which can lead to permanent damage requiring surgical repair, “faith” that a woman can give birth without assistance means dead women and babies since that’s not actually universally true, placentas don’t always ‘fall out’ and unmedicated manual placenta evacuation is apparently excruciatingly painful, there’s no good reason to not cut the cord (though there isn’t really a good reason to do so either- it’s a medically neutral choice), and skin-to-skin doesn’t prevent PPH.

Also, being a tub of water means you won’t be able to actually measure how much blood is lost, so how will a midwife know if there’s been a hemorrhage? Oh right, she won’t, until and unless it’s so bad it’s impossible to ignore, so probably life-threatening. Not a win, not a win at all.

Daleth

Also, being a tub of water means you won’t be able to actually measure how much blood is lost, so how will a midwife know if there’s been a hemorrhage? Oh right, she won’t, until and unless it’s so bad it’s impossible to ignore, so probably life-threatening.

It’s also what killed Claire Teague, who bled to death when the independent midwife failed to recognise retained placenta after a homebirth. The midwife responsible, Rosie Kacary, said in her defence that at least Claire had had a lovely homebirth and the husband should try and remember that.

Linden

The absolute heartlessness and irresponsibility of these people…

Jacob Bunton

“pushing on not 10 cm can lead to seriously bad complications”
Evidence please?????

This is what happens when lots of women have been cared for with an epidural then that same care is applied to women in spontaneous labour non-medicated, and are climbing the walls, panting and puffing, sweating and doing everything in their power not to push, even though every part of their being is telling them to, because a high and mighty birth attendant, call what you will, is standing over them saying, ‘No no no, you are only 7cm’.

Lets be clear with an EPIDURAL YES wait. Anterior lip or 9cm? YES WAIT. Gone. Now what? WAIT for descent at least one hour+ Got the all clear. OK go.

Dr Reed “I am yet to find any evidence that pushing on an unopened cervix will cause damage. I have been told many times that it will, but have never actually seen it happen. Borrelli et al. (2013) found no cervical lacerations, 3rd degree tears, postpartum haemorrhages in the women with an early pushing urge. A recent review of the available research (Tsao 2015) concluded: “Pushing with the early urge before full dilation did not seem to increase the risk of cervical edema or any other adverse maternal or neonatal outcomes.”

Amy Tuteur, MD

You need to cite the actual references along with the quotes.

Jacob Bunton

How about you give the evidence Dr. Amy?

moto_librarian

So that 2013 study was limited to 60 participants. That’s hardly a robust sample size.

Jacob Bunton

I know poor sample size. But you can do better can’t you?

moto_librarian

And seriously? The Tsao was an undergraduate research publication.

Jacob Bunton

Yeah god forbid an undergrad! I know you can do better librarian. Come on share the evidence. Pushing on an undilated cervix when not quite fully, in spontaneous labour, the trauma it must cause, must be loads of evidence its quoted every day on labour ward.

momofone

Do you even listen to yourself? She is telling you IT HAPPENED TO HER.

moto_librarian

At what point is research considered settled, Jacob? If there is overwhelming evidence that pushing on an undilated cervix can cause lacerations, why would they keep studying that? At some point, it enters the textbooks as a verified fact.

moto_librarian

But hey, these are great articles for me to pass on to colleagues who teach medical information literacy. It’s always good to have examples of poor research.

Heidi

I have heard about a similar protruding lip from a homebirth midwife friend. She described a finger like protrusion with a swollen satsuma sized bobble on the end. She massaged essential oils into and it eventually moved up out of the way.

Ugh, I read this in that “article” and it made me feel dizzy and sick. I’ve had my cervix chemically cauterized, had my water broken and had it hit during intercourse, and just hell no.

Jacob Bunton

Did you really read the article or just the comments?

Heidi

The *author* of the damn article wrote that comment.

Jacob Bunton

Great. Ok librarian, what is the evidence for pushing on on an unopened cervix, causing damage, for a woman without an epidural?

Charybdis

How about her own personal experience? Or does that not count in your book? You seem to be all about anecdotal experiences when they support you and your way of thinking.
She was pushing on an incomplete cervix and suffered a cervical tear. Or are calling her a liar?

moto_librarian

If there’s no evidence of harm, why is pushing on a undilated cervix listed as a risk factor for cervical lacerations in obstetric textbooks?

Interesting that in all those comments, these hack midwives aren’t being all “hands off.” Yeah, they aren’t doing a true vaginal examination, which might actually provide useful information, but are MASSAGING women’s cervices with essential oil. How does this not encourage introducing bacteria and pathogens all up in there? How safe could rubbing concentrated plant oils where mucous membranes are be? FFS, douching with watered down vinegar is now known to be more harmful than beneficial.

maidmarian555

I have really sensitive skin and, frankly, wouldn’t apply even massively diluted essential oils to it as I could guarantee a fairly painful reaction within a very short space of time. The idea of having somebody ramming a load of them up my vagina into my cervix is…….excruciating. Can you imagine how much more painful it would be if that crap got into a tear? (Although, of course, what with all the fairy dust and dim lights one presumes they’d claim that tears wouldn’t happen in this scenario). Ouch!!!

Heidi

I once put 3 or 4 drops of tea tree oil in a full tub of water, hopped in, and it felt like someone had set me on fire. I don’t even think I had a chance to sit down to see what it felt like in more sensitive parts. It was excruciating and my legs were beet red for a while. So, nope, no birthing in tea tree lakes for me. And I would never put an essential oil in my vagina. I have a very short list of items that go there!

maidmarian555

I mean, that’s “Having a Vagina 101”. Don’t put weird substances up there! (Although having seen the articles this week warning women not to put wasps nests in, clearly there is a market for this insanity).

Jacob Bunton

Did you actually read the article or just to comments?

AnnaPDE

You know what happens in that case? For example ruptured cervix. My sister in law can tell you just how much fun that was. Oh and the kid was pretty flat too for a few minutes. (Her midwife hadn’t bothered to look properly and just said “yes, it’s fine, now push” even though as it turns out SIL wasn’t completely dilated.)
So what about just shutting up instead of writing inordinate amounts of totally knowledge-free drivel?

Mattie

Just to try and understand better, is this ‘directed pushing’ on an insufficiently dilated cervix, or like a woman just feeling an early pushing urge (as in an OP presentation triggering an early pushing urge) and her body starting to bear down but without her actively trying to push. (Did that make sense?)

AnnaPDE

SIL felt a bit of an urge to push, but as a doctor herself, she obviously wanted to know if she was sufficiently dilated — she thought it was pretty painful and wanted to make sure. The midwife made some noises about not being a wuss, childbirth being painful and that it’s all great to push if she feels like it. Turns out it wasn’t and she should have taken the time to check properly instead of just taking a cursory glance.
It probably also didn’t help that my niece had a 40cm head circumference. For the next two kids, despite the same size heads, SIL demanded proper measurement & second opinion before she started pushing, and had no tearing whatsoever.

Mattie

That’s horrifying 🙁 god the pain! Your poor SIL

moto_librarian

I can say that for me, it was the uncontrollable urge to push. I had a “lip” left that she thought would resolve; apparently, it did not.

Mattie

Not liking cause I like, that’s awful! Must have been so painful 🙁 would an epidural or a stronger epidural have helped in that instance?

Jacob Bunton

Exactly, when a woman is unmedicated and in spontaneous labour follow the woman’s urge to push and it should be an overwhelming urge – NOT someone else saying ‘yes, its fine, now push.’ How the hell do they know? Makes no sense at all and can lead to complications as stated above.

MaineJen

You’re not listening. We’re ALL telling you there is often an overwhelming urge to push before full dilation. You’re still saying the same crap.

AnnaPDE

That’s the point. The urge to push has very little to do with whether the cervix is actually ready for it.

My SIL felt like pushing. A lot. She still held back because her rational, knowledgeable mind knew that she should be waiting until fully dilated.
And the midwife took her urge to push as sufficient indication that she’s ready, instead of actually checking. Because hey, who cares for centimetres when you can go off “feels like pushing”, right?
So she just lied and gave the go-ahead for my SIL to let her body do what it wanted to do, and hey pronto, this wonderful intuitive approach was rewarded with a massive cervical laceration with lots of lost blood plus a kid who only made it thanks to NICU.

But yeah, let’s see some more totally medically incompetent claims about what to “feel” during childbirth from someone who has no idea what having a uterus feels like.

What a useless paper. They relied on the judgment of the midwife as to when the woman had an ‘early pushing urge,’ no independent assessment. You can see the noise in the data by noting that EPU incidence varied from 2.3% to 20%, depending on the midwife.

I’m no OB, but from the paper, it looks like they only noted dilation as measured by one single midwife. Dilation was 8-9 in about half of the ‘EPU’ diagnoses – and no note of how close to the ‘EPU’ time the most recent measurement was made (they hinted that it was between 30 and 90 minutes). In only 8 of the 60 cases did the midwife coach the woman to go ahead and push, rather than try to help them stop. This is a teeny tiny number to see any effect at all, and they did not break out those particular 8 cases in terms of outcomes (and there were some negative outcomes – assisted deliveries and tearing). We don’t even know, from the paper, if the 8 cases of ‘go ahead and push’ had the most dilation at the last measurement (were they among the 13 8cms, or maybe the 13 9cms? Did they include the women were intervention was given to ripen/induce after the measurement?) and were getting close to ‘favorable’ at the time of pushing. All we know is that the operative deliveries were concentrated in the women with the least dilation.

The paper tells us nothing at all about pushing on an unripe cervix. Why did you think it did?

I can’t find Tsao 2015 – you need to learn how to cite.

swbarnes2

Tsao 2015 isn’t in Pubmed, if that’s where you are looking. You have to just google. It’s like a thesis for a midwife student, I guess. It says right there “Peer Review Status : Unreviewed”

Roadstergal

Thanks! Silly me for thinking he would cite an actual paper.

MaineJen

“The midwife knows that if the woman feels relaxed her labour will progress.”

Then the midwife knows nothing.

Not reading any further; you lost me right there.

Linden

You know what, very little about birth is predictable. very little about pregnancy is predictable. And it is hilarious to read a man with these nonsense claims and generalizations about something that he will never experience.
What helped me relax was the epidural that gave me pain relief. What made it possible to push was the little nap I got between 6cm and 10cm, completely pain-free. What helped my son’s cerebral oxygenation was not what midwives did or did not shout: it was the fact that his heartbeat was constantly monitored if he ran into trouble. It was the fact that there were medical interventions that meant I wasn’t laboring uselessly for hours on end.
F*ck the birthing pool. F*ck elaborate breathing patterns. F*ck not disturbing the mother and baby (I almost died by choking on some toast, of all things. The nurses were magnificient in their rapid response. F*ck people who think PPH can be prevented by skin contact.
F*ck this stupid magical thinking that kills women and babies.

moto_librarian

Would you like to know what can happen when you have the uncontrollable urge to push when you haven’t fully dilated? A cervical laceration. I began feeling the urge quite strongly at 9 cm., and that’s likely why I had that particular complication. But please, go on with your mansplaining.

Jacob Bunton

Is this a scientific study? What was the sample size?

Linden

Can you read? It happened to *her*

Roadstergal

Hi, Jacob Bunton!
I have a few follow-up questions.

Are you still under the impression that amniotic fluid is actually water?

Are you still confused about the mechanisms by which newborns can (and do) drown in water, as you questioned below?

Are you still confused about the mechanisms by which newborns can (and do) aspirate birth tub water contaminated by pathogenic bacteria?

Are you still confused about how a fetus in the womb gets its oxygen, and why that is no longer a viable source upon delivery?

I just think this is useful information for anyone considering care with Jacob Bunton to have.

MaineJen

It’s a thing that happened to a real, actual woman.

Jacob Bunton

I know, what I am trying to highlight to moto_librarian is that women’s individual birth stories are important, they do matter.

In reference to my above comment and what caused a barrage of abuse from the above commentator, I was simply reiterating back to moto_librarian what she said to me.

In regard to laceration, though moto_librarian may not wish to answer this on a forum…

‘When you were actively pushing was someone coaching your pushes. I.e telling you to push and how long?’

‘Did you have an epidural?’

By no means am I undermining your experience.

momofone

“what I am trying to highlight to moto_librarian…”

I’m fairly sure she doesn’t need you to highlight anything to her. You might try listening to what SHE is saying, though, just to try something new.

moto_librarian

Had you bothered to read anything else that I posted, you would know that the birth was completely unmedicated – SROM at 38+3, arrived at hospital dilated to 9 cm., pushed in every position imaginable, no heplock/I.V., even drank Sprite between contractions. Once I became utterly exhausted, the nurse did help me count to focus my pushing. My placenta delivered spontaneously 5 minutes after I delivered without the aid of active management. And then I began bleeding out.

And before you decide to engage with me further, I have a suggestion for you. That delivery required a manual examination of my uterus in which the midwife was in up to her elbows, done without pain medication because there wasn’t time to run an I.V. Try sticking three of your fingers up your urethra and let me know how that feels. I’m fed up with this bullshit that labor and delivery pain is somehow different or special from other types of pain. It’s not.

MaineJen

Now, moto. Jacob is simply trying to educate you about your own experience! Aren’t you silly to think that you’d know more about it than him. /sarc

moto_librarian

Obstetric textbooks list pushing on an undilated cervix as a risk factor for cervical laceration, along with precipitous labor and cerclage. My delivery wasn’t truly precipitous, but I can say that I had less than six hours of active labor with contractions (My water had been broken for at least six hours before labor actually began).

moto_librarian

“The midwife knows it is not wise to mix active management with physiological third stage, as this increases the risk of PPH.”

What the fuck does this even mean? Active management is designed to PREVENT PPH, you colossal idiot! We have reams of documentation proving that active management prevents women from, you know, dying, so how can anyone with half a brain make a statement like this?

Jacob Bunton

A ‘safe birth’ is predictable.
An actively managed birth is quite predictable.
The obstetrician knows the risks of his/her procedures, and has faith that he/she can handle them with another procedure, if necessary.
For instance if the epidural he/she has given slows a mother’s labour, he can speed it up with pitocin. If that same epidural prevents her from pushing he can use forceps or vacuum. If this causes a third or fourth degree tear he can repair it. If the above results in a PPH he can manage that and if she still bleeds after everything else is done, he can perform an hysterectomy.

yugaya

Really? Is this passive-aggressive attempt at “interventions cause complications” all that you have? We’ve seen better and funnier trolls.

Jacob Bunton

These were the words of an obstetrician not a troll

yugaya

Words of other people are usually quoted by decent folks. You in no way indicated in that comment that you were quoting someone.

Azuran

Epidurals are 100% requests of mothers. It’s analgesia. Way to blame women.

Pain is bad, everyone know it’s bad. It slows healing and makes recovery longer.
In any other medical context, anyone who recommended that patients don’t use pain control would be considered horrible care provider and probably be fired.

And no, only an idiot with horrible medical training would think that safe birth is predictable. You can never predict outcome of birth. Complications can always happen to anyone for no reason. You are a danger for your patients if you think you can predict their birth.

Jacob Bunton

These were the words of an obstetrician. I agree every birth is unique. That is true. But I also agree with this obstetrician births generally follow a pattern. No one is denying any women pain relief. What is being denied in some hospitals is the TYPE of PAIN RELIEF. There is pharmacological and non-pharmacological pain relief and BOTH should be offered. For example, Not epidural or nothing. That is cruel and inhumane.

yugaya

I don’t want non-pharmacological pain relief because it is nowhere nearly as effective and I find withholding adquate pain relief from women in childbirth to be a form of patriarchal abuse . You are free to start offering non-pharmacological pain relief as equal option to men with kidney stones instead. I mean, I’m sure there is a reason why passing a kidney stone hurts right? And besides, our bodies surely cannot grow a kidney stone too large. While you are at it, throw in some fear-pain cycle mansplainin’ too.

Amy Tuteur, MD

What an amazing coincidence that what you believe women want is what you want for women! Isn’t this more about what’s good for you than it is about what’s good for babies or mothers?

The Computer Ate My Nym

A number of pain relief options are offered in hospitals, including non-pharmacologic methods and non-epidural pharmacologic methods. This claim that it’s “epidural or nothing” is meant to scare women into accepting a painful, dangerous birth with an undertrained attendant. It’s a complete falsehood. An epidural is impossible in the home birth setting, but listening to music, soaking in the tub in the first stage of labor, walking between contractions, etc are available and encouraged in hospitals. Well trained midwives also work in hospitals, with OB backup immediately available if needed.

MaineJen

Hi again Jacob. Actual woman, not an obstetrician. I actually wanted effective pain relief during labor, so I got an epidural and it relieved my pain, and I went on to have a lovely birth. At no point did I feel the need to climb into a tub. (Well, I was in a tub for the first part of labor, but it got annoying so I climbed out again. The end.)

Real actual women do not care what Jacob Bunton wants.

Azuran

No one is saying epidural or nothing. I was offered a huge range of useless natural ‘pain relief’
However, I consider telling women to breath through it to be cruel and inhumane. In NO other medical setting would this be recommended.
If my dentist had even asked me if I wanted to breath through my wisdom tooth extraction instead of having local analgesia, I could have sued him and make him lose his licence. And if I had refused local analgesia, he would have 100% refused to operate on me.
Jesus I’m a vet, and not giving real proper analgesia to pets is malpractice.

Women in childbirth are not forced to have any kind of pain relief they don’t want. They can breath, and hypowhatever themselves all they want, sit on a ball, yell, chant, crush their husband’s hand, have them give massages or whatever.
But at some point you have to be realistic, very little non-pharmaceutical ‘analgesia’ techniques are actually significantly effective.
And waterbirth IS potentially dangerous, so no, doctors and hospital are absolutely not required to offer it (although, a HUGE number actually do)

momofone

“And if I had refused local analgesia, he would have 100% refused to operate on me.”

I thought this might happen to me recently. I have a life-threatening allergy to local anesthetics. A couple of months ago I had to go the ED for the proverbial “worst headache of my life,” and after a CT scan showed no bleeding, the doctor said they needed to do a lumbar puncture to rule out subarachnoid hemorrhage. I said that was fine, but that I could not be numbed, and he was horrified. It took him a little while to find a nurse anesthetist who agreed to do it, and he did it reluctantly. I think it was harder on him than on me–he said he had never done it to someone who was numb and hoped he never had to again. Maybe I should have requested a tub?

Azuran

Well of course there should be exceptions for actual medical reason that makes certain types of analgesia dangerous. (and possibly more research for a wider range of actually useful analgesia protocols.)

momofone

Oh, definitely. I just was pointing out that even though I was consenting the doctor and CRNA were hesitant to act without analgesia.

Who?

Do obstetricians know the risks of not performing procedures?

Do you agree that those risks should be spelt out?

Jacob Bunton

When there is a shoulder dystocia mws and/or drs perform the procedure.
In regard to a previous commentators post it is important to know what the risk factors are for shoulder dystocia, pph etc but professionals are prepared and skilled to manage any eventuality.
When the woman is bleeding more than normal mw and/or dr intervene.
If there is a severe tear requiring suturing it is sutured.

momofone

Can a midwife perform a c-section in an emergency (or because that’s what I choose)? Because if not, they’re not much use to me.

Amy Tuteur, MD

Apparently midwives don’t intervene when there are complications. That’s what the Morecambe Bay report found. The author was careful to note that the preventable deaths he investigated were NOT anomalies but the result of midwifery philosophy.

momofone

I notice that you come in and state several claims as fact, then completely ignore commenters’ responses to you. You seem to want to state your case, but not actually defend it.

And just to address one claim you’ve made, regarding what “(t)he obstetrician knows,” the only accurate way to complete that sentence from my perspective is “a hell of a lot more than I do.” You and your claims are exactly why I would never allow a midwife near me; give me an OB any day–exactly because they can perform procedures. I’d much rather have someone with expertise doing so than some idealogue who sees my hemorrhage as a time to let me “go inside myself” or some other such bullshit. If I have a tear, you’re damn straight I want someone who can–and will–repair it. I don’t give a damn how you think other people’s experience of giving birth should go; if you want to suffer needlessly in search of some primal part of yourself, then figure out how to get pregnant and have at it. I’ll stick with a professional every time, thanks.

Jacob Bunton

Your response is emotive, means we are probably getting somewhere. You have reason to be angry. Read further and you will notice I do respond to most messages. Sometimes I post not directly to one person, as more than one person is saying the same thing. Midwives and Doctors can both prevent a haemorrhage, suture etc by the way I said nothing about ”going inside myself’, your words not mine. I argue for choice, fully informed CHOICE that means women who want a waterbirth but within a hospital (as opposed to freebirth at home) CAN. That means women who choose epidural can. It means women, all women, can equally choose how they wish to birth safely without being threatened, belittled, humiliated or that choice being taken away from them. Let me remind you BOTH midwives and doctors are professionals.

momofone

I’m not sure where you see us “getting,” but you are correct that my response is partly based on emotion. It angers me to read your comments about allowing/encouraging people to suffer because of your own ideology.

I actually do not see your responding to most messages, but more of a drop-and-run kind of thing.

I’m interested in hearing your thoughts about maternal request c-section. I’m assuming since you are such a champion of the woman’s choosing for herself, you must be quite a proponent of MRCS.

Jacob Bunton

I drop and run as you put it because I am busy. I have other demands on my time! i.e caring for and as you guys would put it ‘delivering’ babies. My time is limited. I am not retired like Dr Teuter. I engage when I can because I am interested in your thoughts.

momofone

Because you are interested in our thoughts, or because you want to proselytize? I don’t hear a lot of interest in listening, but I hear a lot of “let me explain this to you.” (I hate the word mansplaining, but that’s what I’m talking about.)

Nick Sanders

Maybe if you’re so busy, you shouldn’t be starting things you don’t have time to see through properly?

yugaya

” I argue for choice, fully informed CHOICE that means women who want a
waterbirth but within a hospital (as opposed to freebirth at home) CAN.” Bullshit. What you argue for and are actively enabling is going against medical advice as in a woman with history of PPH is never a good candidate for a waterbirth and waiting it out third stage in a low resource MLU setting. Your replies here are disturbing in a way that you are doing your best to imply that magic of dimmed lights and you acting out of your scope saved that woman from a complicated birth and bleeding out to death on the ward. It didn’t. Hundreds of thousands of women in developing world die each year far, far away from blue lights and all medical interventions during completely natural, physiological childbirth. If only they had someone like you holding the space, everything would turn out just fine!

What he’s arguing for is the equivalent of the last part of treatment I got for a broken foot when I was eighteen. When I went to have the cast taken off, the doctor said I should come the next day for physiotherapy. I said, “Oh no! This is my first year at the university, I already missed two days, I intended to make the journey tonight. MUST I have this therapy?” “Well, not really, if you don’t have pain,” he said. I did not have pain… then, Two months later, a doctor at the university threw a fit over someone being this irresponsible not to tell me that EVERYONE should get the freaking therapy and it wasn’t done to relieve any pain you might have at the moment but for the future. I started treatment immediately but it was too late. I had YEARS of pain.

That’s what you get when you treat patients like clients who should be made to smile and cross the line between “safely” and “pretended safely” , like Jacob does.

Oh, and did I miss the part where it turned out that the first doctor was not an orthopedist but a freaking SURGEON? I’ll never know what the hell he was doing substituting for an ortho. But it’s amazing how much this “professional” situation resembles the one Jacob advocates for, isn’t it?

Azuran

Here’s the thing about medical choice: Not every ‘choice’ is valid and should be presented. Doctors have the obligation of presenting medically valid choice, not fancy ‘I’m a warrior’ choice.
They have responsibility and accountability. The choices they provide are therefore medically sound choices.
Water birth is not a proven safe and effective treatment, therefore no matter how much you like it, doctors are under no obligation to offer it as a valid choice. Just as they are not required to present other pseudoscience like homeopathy.
If a woman doesn’t like what her doctor is offering, than yes, her choice are to either find another who does or birth alone at home. A doctor does not have to practice in unsafe ways because that’s what their patients wants.

Jacob Bunton

FACT: It goddamn is about CHOICE. It is the woman’s CHOICE. She is not an idiot! Or an incubator. Though some doctors and midwives might have the high and mighty attitude of ‘I know what is best for you dear’, she can make her own decisions. That is WHY it is important to
1. Offer a real choice in the first place by
2. Presenting the risks and benefits of both approaches
3. From latest evidence

FACT: Waterbirth is a safe option for most women and Cochrane Review proves it.

FACT: Maternity services are under obligation to offer it.

Did I really hear you say if she doesn’t like it…well she can birth alone at home? You seriously are telling me that if a woman asked you if she could waterbirth in hospital you would say no and tell her to freebirth!

My God! Reading this, it is really beginning to make sense to me why America obstetric care is in such a mess right now. Yes you are right:

FACT: Birth is dangerous for the majority of women right now…IN AMERICA!

momofone

I read this comment with interest, as what I’ve picked up from your comments has been heavy on the “I know what’s best for you women, if you’d just listen.”

Jacob Bunton

Sorry you thought that momofone. I guess it can sound like that at times and I apologise. It can be difficult presenting concepts that may not be readily ‘mainstream’… can I say that?…or accepted. Though waterbirth to be honest is pretty mainstream now in most parts of the Western world, i.e Australia, U.K, parts of Europe.

momofone

What is the deal with your fixation on waterbirth?

Roadstergal

The most recent report I saw from the UK had 0.6% of deliveries as waterbirths. That’s ‘mainstream’?

Lilly de Lure

Well, to be fair its mainstream over here to offer them and to extoll their virtues in antenatal classes – appaarently though us unenlightened UK ladies are yet to be convinced in large numbers.

Roadstergal

Ooh, mainstream marketing, niche clients?

I hope that’s a good sign, in terms of women over there getting decent information from _somewhere_.

Lilly de Lure

To be fair I think its a bedrock of common sense more than anything else (if you had mass marketing of water birth in the states or anywhere else you’d probably have the same thing) – same as homebirth. It takes a certain amount of time and google fu training to be able to blind yourself to the obvious risks of both homebirth and waterbirth which are pretty obvious to the uninitiated (how hard is it to work out that babies can drown once out of the womb or that time is of the essense in an emergency). Most women, particularly if they go into their pregnancies unversed in the birth wars or birth woo generally, simply don’t have the time or inclination to self brainwash, an awful lot simply want to give birth safely to a healthy child.

maidmarian555

I think this is also why, despite the fact community midwives are really increasing the pressure on pregnant women to go for either homebirth or an FMU that (as far as I know the last time I looked), most women are still choosing traditional labour wards for delivery. Certainly for me I didn’t even bother looking into it last time as I had no real interest in anything other than being as close as possible to actual doctors and operating theatres and a NICU ‘just in case’. It all became a fairly moot point anyway once they’d let me go 12 days over and I had to be induced but it certainly wasn’t something I was concerned about missing out on at all.

Dr Kitty

Exactly.
All my low risk pregnant patients have the option of the following
birth places:

Home
A FMU 20 miles from the nearest CLU
A FMU 9 miles from the nearest CLU
A FMU 2 miles from the nearest CLU
An AMU one floor down from the nearest CLU, both of which are in a new building- all single ensuite rooms, with a level 2 NICU about 20min drive from my practice.
An AMU and CLU in a very old building with a few single rooms, but mostly 8bedded bays for Postnatal women…but on the same site as the regional children’s hospital and tertiary NICU, again about a 20minute drive from my practice.

We have over 100 births a year in our practice.
In the last 3 years we have had 1 planned home birth, no-one opted for the FMU and it is a 50/50 split with women opting for new or old hospitals, with most starting in AMU in each unless induced or risk factors develop during pregnancy or labour.

Women generally opt for the same place for second and subsequent deliveries as they did for the first.

It’s not a lack of choice, it’s that women genuinely don’t want to risk giving birth at home or in the FMU, even when given lots of glossy brochures and having midwives expound the benefits to them.

There are patients of mine who literally choose the 1950s hospital over the new one, just because they feel safer being beside the children’s hospital. Not because they are high risk, or have had bad experiences in the past, but because they value access to expert care over their own comfort.

It’s not what all the NCB stuff says that they “should” want, and yet, it seems to be what they *do* want. I’m listening to my patients and what they are actually saying is that they value outcome over process.

Dr Kitty

Extolling the virtues is correct.
I have yet to see anything about the risks of waterbirths in NHS literature.

Six case reports of fatality in ultra-rapid metabolisers were enough to have the MHRA ban codeine in all breastfeeding women in the U.K.

We’ve had many, many more case reports of babies dying from having been delivered in water, and it is still not banned, because their is a vocal cohort of people like Jacob advocating for it.

Nick Sanders

FACT: Maternity services are under obligation to offer it.

Nope, and yelling doesn’t change that.

Azuran

There is a limit to medical choice. I’m a medical provider, and there are rules to the things I can do and recommend. Same goes for human doctors.
You CANNOT force a doctor to give you a treatment that has no medical benefits or might be harmful, no matter how much you want it.

And yes, if she doesn’t want medical help, then she can go back home and do what she wants. She has the right to refuse care, not to demand any kind of dangerous care. And water birth being ‘safe’ (as long as baby isn’t born IN the water) does not mean that it’s appropriate in an hospital. What’s next? Birth in a completely dark room? Forcing everyone to be silent and talk in signs language? Bring your dog? Allow the ENTIRE extended family (like over 30 people) to stay in the room?All of those could probably be done just as safely as waterbirth, doesn’t mean hospital should allow such stupidity.

And yes, If someone came with her dog in labour at my clinic and told me she wanted me to put her dog in a bath to birth her puppies I would absolutely tell her that if she wanted to do that, she’d be doing it at home and not in my hospital. And I’ve actually did turn down the ridiculous demands of a woman once. And in the end she refused to bring her dog in because I wouldn’t give her labouring dog the ridiculous treatment she demanded. And no, I don’t feel bad about it. She had the choice.

BTW, I’m not american and I’m not an obstetrician. But if you wonder why birth is so dangerous in america, you might want to look in a mirror.

Amazed

FACT: While you and your fellow crazies go their merry way and lie and manupulate women to make them want what you want… yes, it is!

Your surgeon equivalent left me suffering pain for years. I have little patience for self-congratulating dangers like you.

Heidi

We can’t hold doctors at gunpoint until they support all our decisions or else we’ll do something “even more dangerous.” You’ve not even explored the logistics of installing tubs and having the important equipment necessary to offer a less safe form of birth in our current delivery rooms. It would cost a lot of money that should be going towards more pressing matters, like providing general preventative care, prenatal care, screening and treating post-partum depression and other women’s healthcare. It’s such a complex issue that involves sexism, racism, poverty, pre-conception health issues and it’s just so very offensive you chalk it up to jacuzzis and dimmers. You are not American it seems and must have no concept of what’s really happening stateside. What are tubs going to do for women who had undiagnosed, untreated high blood pressure or type II diabetes when they became pregnant? What are tubs going to do for women who are killed by their partners post-birth? How are they going to treat PPD (I believe PND in your part of the world)?

More on the logistics, how are we going to fund tubs (and then the transfer equipment for emergencies) and dimmers (dimmers actually are probably on most L&D rooms)? How are we going to be sure they are properly cleaned? We can’t use blow up tubs because those can’t be cleaned well. I’ve worked at a hospital. Housekeeping is already behind. The last thing they need is detail cleaning and sanitizing a labor tub. How many rooms do we close at one time to install a tub? What if a hospital can’t afford to lose even one room for construction? My hospital surely couldn’t spare a room. I barely got squeezed in for a, gasp, induction.

maidmarian555

He is high. I don’t know anyone that would take the ‘if you don’t give me a waterbirth then I’m going to freebirth at home’ route. I’ve had friends who have had waterbirths in AMUs (and one that did it at home- with midwives in attendance) and several more who thought they ‘might’ want one but when it came down to it didn’t- either because it wasn’t possible (no room available in the AMU or there were indications that there may be problems requiring the proper labour ward) or because they decided now that they were actually experiencing labour that they’d much rather have an epidural than a tub of warm water thankyouverymuch. It says an awful lot about him that he’s seems to sincerely believe that tubs and dimmers are more important than basic pre-natal care. It also makes me really worry that this loon is apparently allowed near actual pregnant women. His views are dangerous.

Heidi

I gave birth at a university hospital. I took my childbirth class at the hospital. I’d say there were around 13 couples there and only one was even considering the idea of a med-free birth but was still very open to getting an epidural if she wasn’t feeling it (I have no idea what she chose but if were to place money on it, I’d bet once the pain hit, she chose an epidural). The hospital balances safety with patient demands. Practically no one was choosing a walking epidural so they quit offering them. Makes no sense to offer something 1 in a 100 women even want to try and a considerable chunk of the ones who do try it regret not choosing something else. The anesthesiologist also mentioned they had experienced falls with them so while it is a little unfortunate the occasional woman who wanted a walking epidural could no longer receive it at that hospital, I still couldn’t see the justification for keeping them. Most women are fine with using the removable shower heads in the delivery rooms for pain relief during labor. In fact, I think most women in my area aren’t really that enthusiastic about going the “natural” route.

I have to agree Jacob’s views are scary, especially since he is allowed to work with pregnant women. I can’t believe he bragged about the gamble he took with the patient the rest of his colleagues wouldn’t take on. He thinks we’d be impressed because he lucked up with his little game of roulette. It’s becoming apparent to me it’s a fetish for Jacob that he will take huge, dangerous risks to fulfill. It’s scary there was no oversight when he took the gamble.

maidmarian555

I also gave birth in a University Hospital. I’m lucky in that I live between two large cities so had a lot of choice when it came to where I would give birth. There are two hospitals, about the same distance from where I live, and two FMUs also. The hospital I chose has an AMU on the floor above the labour ward- I know several women who’ve chosen it precisely because they felt it gave a nice mix of the whole ‘fairy-lights, birthing pool, whale music’ experience, with an epidural or c-section just an elevator ride away if things went wrong. The reason I picked the hospital I did from all of the available options (and within a 45min car ride there were more) is because it’s a centre of excellence for fetal medicine and they have an exceptionally well equipped NICU. The likelihood was that if I gave birth anywhere else in the region and my son had been unwell is that we would have been transferred there. Of course I hoped he would not be unwell (and he wasn’t) but I felt much safer being there ‘just in case’. Many of my friends living around here have made exactly the same choice for the same reason. I don’t believe I know that many women for whom a lovely room would be more important on balance than access to the best possible care for their babies. It is really disturbing that this doesn’t seem to occur to him, and I really don’t think that what I’ve seen on an anecdotal level is somehow a vast misrepresentation of how most women actually approach birth- even when infinite choices *are* available to them, they just want what is safest for their babies. And access to pain relief. Birthing pools are really far down on the list of priorities and most of us wouldn’t notice if they weren’t available at all.

EmbraceYourInnerCrone

I honestly don’t get why he thinks “everyone” would want to deliver in a tub in a dimly lit room. I would prefer my health care providers be able to see if there is a hemorrhage, if my BP is going up, etc. And maybe I am a prude but being undressed and in a tub while possibly needing assistance or exams does not a appeal to me at all. Why he thinks that anything a patient “might” want the hospital HAS to provide is beyond me. The last thing I want is everyone bumbling about in the gloom…

momofone

You know what else I want? I want monitors. For baby, for me, maybe even for visitors. I want every kind of monitoring we can have, and I want anyone who walks in to be able to see them from a mile away. So they can, you know, monitor.

OkayFine

Not arguing with your points at all and I’m surely NOT defending this daft person you are arguing with. But the way I’ve seen hospitals around our area handle birthing tubs is by using inflatable tubs. Those tubs come with a liner and each patient gets a new liner. I don’t know if they clean them on top of that but I would really hope so. Each tub is on a platform that can roll it from one room to the next and is filled from the tap in the bathroom. It IS a lot of work to get it set up, fill, empty, etc. I’m not sure who handles all the cleaning aspects but I’ve seen nurses and and midwives do most of the setup and draining.

Heidi

Interesting. I wonder if they can maintain temperature with them? Jacob was mentioning the importance of keeping it at a very specific temp.

OkayFine

When filling up the tubs, they put a single use thermometer in them. I’m sure the tubs cool off after a while but they start out at a specific temp range. I don’t know how they control that if the moms are in them for long periods of time.

Roadstergal

FACT: There are a fair number of women 100% uninterested in stewing in a tepid soup of dilute amniotic fluid, blood, urine, and feces, let alone dunking their newborns in it.

Nick Sanders

Please enlighten me how a midwife would prevent a hemorrhage, let alone treat a serious one.

momofone

Oh, Nick, don’t you understand?! Everyone knows hemorrhages can’t happen in the dark, or with warm blankets in use. Plus, Jacob said at least 13 times (!) that “the midwife knows” exactly what to do at every stage. Isn’t that reassuring?

demodocus

Not only is Jacob a midwife and self-help guru, he’s a psychoanalyst! Do you feel yourself on the edge of a breakthrough? /sarcasm

Jacob Bunton

What the hell!

MaineJen

Well, I read your comment above about all the condescending blather those women who requested MRCS had to go through. Or is it only women who choose unmedicated water birth who shouldn’t be belittled, etc?

Jacob Bunton

An obstetric emergency is handled in exactly the same way in any birth setting. BOTH doctors and midwives are trained in how to manage these situations.

Shoulder dystocia which occurs in 1% of all births is managed exactly the same, regardless of birth setting. If in a pool the woman is asked to get out. Yet its occurrence is rare, as the woman at home or on AMU/FMU is usually low risk and on all fours, this in itself will open the pelvis, also as she leaves the pool this action in itself can be enough.

Post partum haemorrhage
Again, all the above, are risk factors, and more likely to occur on a labour ward or OU (obstetric unit).
When dealing with a PPH the first line management is the same regardless of setting.

Hypoxia is more likely to occur when synthetic oxytocin is used. Its substantial increase in use since the 1970s could also perhaps account for the steep increase in claims being seen.

Breech
Hands OFF a breech is first rule of thumb in obstetric guidelines.
If no descent Lovesett manoeuvre will be used to release the arms.
If on all fours or semi-upright likely delivery of head will not be a problem but there is a manoeuvre that can be done called the mauriceau-smellie-viet manoeuvre. Vaginal breech births are becoming very rare, and this is a posing a real risk to an important skillset being lost forever.

I asked a caseloading midwife ‘how many emergencies have you had?’ She replied, ‘In 25 years of attending homebirths I have had two. We managed it at home ok, mother and baby were well.’

Obstetrician John Franklin
‘Every doctor enjoys his intervention. That’s what his skill and training are for. Some think that nature is in constant need of improvement and others that nature can’t be trusted, but one kind of intervention leads to another and then the doctor is kept busy seeking remedies for his own actions.’

Only a disgusting misogynist will compare like that giving birth in industrialized world with giving birth in a country where women don’t have agency to make medical decisions during childbirth. Not to mention all those slave labour migrant women in Saudi Arabia with no rights whatsoever, many of them getting pregnant and giving birth while being held prisoners by their employers.

You are quite a piece of shit to use that comparison.

maidmarian555

I have a feeling he’d much prefer it if we weren’t allowed to make our own decisions about our own bodies during labour and birth judging by the comments he’s been making here…..(unless, of course, we’re choosing to homebirth in the dark in a manky poo-infested paddling pool).

Nick Sanders

I don’t know about Saudi Arabia, but the UK has socialized medicine, and China has even more of those interventions you seem to think are evil than the USA does, a lot more. Especially C-sections. Last I saw, the Chinese c-section rate was roughly 55%. Maybe the USA should take a lesson from that.

Previous round of such ignorant reports and articles cited Belarus for comparison. During dictatorship which resulted in average life span in that country crumbling, they managed to miraculously cut down maternal and perinatal mortality rates in a way that has never been documented anywhere else ever.

Yeah, let’s compare birth care in USA with a country in which travelers are warned against seeking local medical care and where mortality data is obviously falsified.

“Medical care in Belarus is neither modern nor easily accessible. Hospitals and medical facilities in Belarus are below Western and U. S. standards and lack basic supplies. Trauma care is well below U.S.
standards; Belarus lacks the level of care and competence to deal with these injuries.”https://travel.state.gov/content/passports/en/country/belarus.html

The Computer Ate My Nym

Yes, it is. The US’s medical system is severely hampered both by lack of a universal health care system and by specific political efforts designed to increase the danger of pregnancy for women. Yes, you read that right: politicians in the US deliberately target organizations that provide ob/gyn care to women in the US and when they succeed, the result is much worse medical care and considerably higher maternal mortality. States with more aggressive efforts are those where the survival is the worst.

Link is to a secondary source, but it provides further references to primary sources and a good summary of the problem, which is why I am using it in preference to a primary source.

So are you saying the US needs to spend all our healthcare dollars on jacuzzis in our delivery rooms? Let’s not spend more on preventative care, birth control, reproductive health, food security, helping women get access to prenatal care or anything like that but all we need are jacuzzis and dimmers! America has a lot of room for improvement but spas in our L&Ds should be no where near the top of the list. Doesn’t do crap for women who relied on now shutdown women’s clinics for birth control and prenatal care.

Jacob Bunton

YES! There needs to be a choice. If you want epidural, you can have one. And that is a good thing. What about the woman who doesn’t want an epidural or maybe she is not sure, she thinks she will probably need one but would like to try the water first. Where is her choice! It doesn’t exist. This Heidi could be viewed as preventative care. The rest is important of course, but the birth itself has a huge impact on the woman, bonding with her baby, her family especially if her choice is denied and no meaningful conversation is taken place apart from ‘you can’t have it!’

Heidi

No it is not preventative care. And no, it should not be a priority. You are insane. Prove that our maternal mortality has anything to do with lack of water birth.

Amazed

Preventative care? Water birth is preventative care? I don’t know how things are in the USA but if someone tried to push waterbirth as preventative care HERE, I’d have much to say about the lack of staff to help patients who are immobile. That’s just an example that came to me immediately but I do remember how my father went to the hospital to lift my grandmother after her colon cancer surgery and carry her to the window. He stood there for a while, then placed her in a chair, then lifted her again and held her so she’d change positions. Sure, nurses turned her in bed and all but it would have been nice to have more people around so no one got, say, a back injury from manipulating her and/or injuring HER in the process. She was about 120 pounds then but they couldn’t handle her like a sack of potatoes, after all. And one of the thinly spread nurses was freaking tiny.

Frankly, I can’t envision a healthcare system being this richly funded that waterbirth could ever be considered a reasonable weight on taxpayers’ money.

yugaya

“Hands OFF a breech is first rule of thumb in obstetric guidelines.” No, it is shit that killer birth quacks like Ina May Gaskin ( 1 in 11 mortality rate at The Farm for breech birth according to the report she authored) and Lisa Barrett ( three dead breech babies in less than two years) propagate.

First rule of thumb in all current obstetrical guidelines is a CS for breech you idiot.

“Women should be informed that while evidence is lacking, continuous electronic fetal
monitoring may lead to improved neonatal outcomes. [New 2017]

Where should vaginal breech birth take place?
Birth in a hospital with facilities for immediate caesarean section should be recommended with
planned vaginal breech birth, but birth in an operating theatre is not routinely recommended.

Women should be informed that adherence to a protocol for management reduces the chances
of early neonatal morbidity. [New 2017]

Assistance, without traction, is required if there is delay or evidence of poor fetal condition.
[New 2017]”

…and so on. That lethal hands off breech idiocy is not mentioned even once in the source you are referencing. I don’t need to be an obstetrician to notice that, do I?

Azuran

What are you even talking about? According to your own link, First rule of breech isn’t hand off.

First rule is apparently: Try a version

Second rule: If version fails, talk to women about the risk/benefits of c-section vs vaginal birth (and they say very clearly that vaginal birth has a 4x higher risk of death for the baby)

Third rule: IF woman wants vaginal birth, make sure she is a good candidate, meaning: Prenatal testing.

Then there is a LOT more blabla about risk/benefits and testing to make sure it’s safe

Then Constant foetal monitoring is recommended and labouring in a hospital with access to immediate c-section.
A lot more monitoring during the birth to make sure everything stays perfect.
Then more talk about how your OB shoudl be skilled is diffent kind of manipulation.

Where in there does it says that you should keep you hands off a breech baby any more than during a normal presentation?

yugaya

Nowhere. But some MLUs in UK are so off the rails that this deadly hands off breech nonsense has been legitimized in lower level hospital guidelines.

Martha G

Worryingly, here in the UK, I’ve seen a lot of midwifery ‘leaders’ advocating against a CS for breech, and are all for adding it to the list of high risk indications for which we should now be prepared to undergo natural delivery.

ME? I’m adding this disturbing trend to the list of reasons I will never give birth in the UK (and since I’m resident here and not getting any younger, possibly never will at all). How ’empowering’.

yugaya

“Shoulder dystocia which occurs in 1% of all births is managed exactly the same, regardless of birth setting.”

Ya, sure. Outcomes aren’t even remotely similar though.

yugaya

Also this from RCOG guidelines: ”

6.3.1 How should shoulder dystocia be managed?
Shoulder dystocia should be managed systematically (see appendix 1).
Immediately after recognition of shoulder dystocia, additional help should be called.The problem should be stated clearly as ‘this is shoulder dystocia’ to the arriving team.”

You carry a team in your pocket to homebirths?

yugaya

“Managing shoulder dystocia according to the RCOG algorithm (see appendix 2) has been associated
with improved perinatal outcomes.

Help should be summoned immediately. In a hospital setting, this should include further midwiferyassistance, including the labour ward coordinator or an equivalent experienced midwife, an experienced obstetrician, a neonatal resuscitation team and an anaesthetist.”

You carry a neonatal resuscitation team that will respond in seconds in there as well? So the more accurate and honest statement would be that while in an OOH birth you will follow all the basic steps for management of SD that you would in a hospital, it is a birth setting where the full recommended response that improves outcomes is – impossible to achieve.

Jacob Bunton

USA 1% of births are homebirth
99% are in hospital
Shoulder dystocia is rare 1% of all vaginal births
More common on a labour ward
Why?
– Induction of labour with drip of synthetic oxytocin
– Synthetic oxytocin augmentation (to speed up contractions)
– Prolonged 1st or 2nd stage
– Operative vaginal delivery

Alongside Midwife Unit – is exactly that. It is alongside the obstetric unit. It is on the labour ward just the rooms are designed differently, i.e more like a home away from home. It offers women, who are predominantly low risk, to use the pool if they wish.

There are emergency bells in these rooms, if and when needed.

yugaya

“USA 1% of births are homebirth
99% are in hospital
Shoulder dystocia is rare 1% of all vaginal births
More common on a labour ward”

What’s the death rate for breech babies nowadays in hospitals? Oh right, in hospitals, that thing called evidence-based and medically recommended CS has annulled the increased risk of fetal/neonatal death that used to be associated with breech pregnancy.

” Vaginal breech births are becoming very rare, and this is a posing a real risk to an important skillset being lost forever.” I will take more alive, unharmed babies over a skillset that even under best of conditions ( according to you) is associated with mortality rates from half a century ago.

maidmarian555

He’s totally missing the fact that women are *choosing* c-sections for breech babies because it’s safer for the baby. Of course, this is apparently less important than midwives and OBs being able to basically use these women and babies as practice so they don’t lose this ‘important skillset’. It looks like he might be UK based, I can only hope he’s doesn’t work in the hospital where I’m planning on having #2. Although it sounds like he wouldn’t want me as a patient anyway, considering I’m planning on another c-section. Which I am pleased about seeing as I don’t really want the people in charge of my care sharing personal details of my next birth online with total strangers.

yugaya

Process over outcome mindset, especially troubling since the outcome he wants ignored so that he can practice NCB hands off breech bullshit is in year 2017 unacceptable rates of fetal/neonatal death.

maidmarian555

He needs to talk to my MIL. My OH was born breech (in 1975). Back then, c-sections were neither as common nor as safe as they are now. Even so, they attempted a version 3 times because they didn’t *want* to deliver him breech. Each time he flipped and the final time it was too late for them to try anything else. She says the experience was terrifying. It really irritates me that they romanticise experiences and a past that simply didn’t exist for those who actually lived it. Also, I’ve had a couple of friends with breech babies. I know things can be different in the US with insurance considerations etc but here in the UK everyone I know was given a choice about how they wanted to deliver their baby. They chose c-sections. Because (funnily enough) the risks of losing their child unnecessarily far outweighed the risks of surgery for them and they didn’t give a fuck about whether the attending midwife was getting enough practice at delivering breech babies to ensure her skillset was maintained.

Who?

You’re assuming the safety of mum and baby are the point.

If you only realised that all Jacob’s feelings are the point.

Lilly de Lure

Indeed – the traditional skillset necessary for the correct use of birth hooks was lost centuries ago and I don’t think even the craziest traditional/ home birth advocate would lament the loss.

yugaya

Don’t give these fuckers any ideas. Ina May Gaskin lamented how a homebirth with placenta previa was entirely possible but she unfortunately never had the chance to attend one like some Dutch midwife a few centuries ago did.

“Vrouw Schrader, like Louise Bourgeois and Justina Siegemundin, discovered on her own how to deal with placenta previa. “All three midwives came to the conclusion that the best way to handle these extremely dangerous situations consists of delivery the woman as soon as possible.” Frau Siegemundin did this by piercing the placenta with a needle to drain away the amniotic fluid, while Schrader and Louise Bourgeois concluded they had to remove the placenta first and perform a version and extraction immediately after that. Vrouw Schrader encountered her first placenta previa on her 661 st case and lost the mother. Almost exactly six hundred births later, she had her second placenta previa, executed her plan and saved the mother. The child had been dead for some days. All in all, she dealt with ten cases of complete placenta previa and only lost two mothers,”

2 in 10 placenta previa maternal mortality! I’m sure Jacob has the sadz that the skill of vaginal placenta previa birth is lost.

Of course, this is when placenta Praevia was only apparent during labour when placenta was palpated through a dilated cervix, and provided the woman hadn’t already bled to death from an antepartum haemorrhage.

Jacob seems keen to support maternal choice- would he agree to attend a woman with PP who refused CS?

If not, clearly he believes there is a level of risk at which it is unethical for a HCP to acquiesce to a dangerous plan.

I want to know where he puts that level.
What is the risk of maternal mortality and morbidity and neonatal mortality and morbidity at which “supporting” a woman is no longer ethical?
Hard numbers.

If there is no level of risk which ought not to be supported, then Jacoob needs a swift refresher in the NMC code of practice.

Well, 20% mortality rate is better than 100% mortality rate, but still completely unacceptable when you could just go to the hospital and get a freaking C-section!

Lilly de Lure

Oops, my bad – never underestimate crazy! SMH

Charybdis

Where’s Mel? She could give some information on having to use obstetric chains or a “come along” during cow birth.
Or maybe a fetatome. Those are some mighty gentle interventions there.

Charybdis

We have one regular poster here whose first child was premature and she experienced shoulder dystocia. You cannot, absolutely cannot predict the incidence of shoulder dystocia in any pregnancy. It happens with large babies, small babies and premature babies. It happens in spontaneous labor, augmented labor and induced labor. It happens if a woman is in a tub/pool, free to walk around and change position, on all fours, squatting, or confined to bed with an epidural. It happens with no pain relief, IV/IM pain relief and epidurals. It happens in home births, midwife-led units and hospitals.
Women who cannot control their pushing can suffer perineal tears. Women who can control their pushing to a certain extent can suffer perineal tears. Women who have perineal massage, etc to “prepare” the perineum can tear. Anything from relatively minor first degree tears to devastating third and fourth degree tears. Episiotomy, while not a standard, regular occurrence these days, is an option to prevent/manage the potential for perineal tears. Cervical tears can also happen with uncontrolled pushing on an incompletely dilated cervix. All of which cannot be predicted with any certainty during labor.
Things can be going along swimmingly, right up until they aren’t and you can be considered “low risk” right up until the shit hits the fan. Then, time is of the utmost importance in dealing with whatever the issue is. Prolapsed cord, placental abruption, uterine rupture, amniotic embolism, shoulder dystocia, and other cord issues (short, nuchal, knotted, etc) need to be addressed immediately.
Then, if you are of the “breech is just a variation of normal” mindset, you have to deal with potential head entrapment, nuchal arms, cord prolapse.
How do you deal with/address these points when they come up? Or do you not mention them at all because that is somehow encouraging interventions?

Charybdis

We have one regular poster here whose first child was premature and she experienced shoulder dystocia. You cannot, absolutely cannot predict the incidence of shoulder dystocia in any pregnancy. It happens with large babies, small babies and premature babies. It happens in spontaneous labor, augmented labor and induced labor. It happens if a woman is in a tub/pool, free to walk around and change position, on all fours, squatting, or confined to bed with an epidural. It happens with no pain relief, IV/IM pain relief and epidurals. It happens in home births, midwife-led units and hospitals.
Women who cannot control their pushing can suffer perineal tears. Women who can control their pushing to a certain extent can suffer perineal tears. Women who have perineal massage, etc to “prepare” the perineum can tear. Anything from relatively minor first degree tears to devastating third and fourth degree tears. Episiotomy, while not a standard, regular occurrence these days, is an option to prevent/manage the potential for perineal tears. Cervical tears can also happen with uncontrolled pushing on an incompletely dilated cervix. All of which cannot be predicted with any certainty during labor.
Things can be going along swimmingly, right up until they aren’t and you can be considered “low risk” right up until the shit hits the fan. Then, time is of the utmost importance in dealing with whatever the issue is. Prolapsed cord, placental abruption, uterine rupture, amniotic embolism, shoulder dystocia, and other cord issues (short, nuchal, knotted, etc) need to be addressed immediately.
Then, if you are of the “breech is just a variation of normal” mindset, you have to deal with potential head entrapment, nuchal arms, cord prolapse.
How do you deal with/address these points when they come up? Or do you not mention them at all because that is somehow encouraging interventions?

Chi

Why are those more things more common on a labour ward? Umm cos MAYBE those things are only AVAILABLE on a labour ward??

As far as I’m aware, home birth midwives (particularly CPMs which we all know are shit) do NOT have the ability to prescribe/carry drugs. MAYBE they can have Pitocin, I don’t know, but the fact of the matter is that by the time that they get to the point where the drugs are necessary, the patient has either been transferred to a hospital anyway, or it’s too late for it to make any difference.

How freaking dense ARE you? You are the worst sort of mainsplainer who thinks he knows more than a FEMALE obstetrician.

Birth is straightforward, until its not. It is a PROCESS. The outcome SHOULD be a healthy and alive mother and child. But because you idiots are obsessed with birth being ‘natural’ people buy into the propaganda and babies (and sometimes mothers) DIE.

1% is not rare. It is, in fact, terrifyingly common. There were ~4,000,000 million births in the US last year. 1% means 40,000 shoulder dystocias. We know that babies born at home have a 450% higher mortality rate than those born in hospital- and the most common complications are stillbirth and shoulder dystocia. If all of those 40,000 shoulder dystocia babies were born at home, how many thousands would die? How many more thousands would be permanently maimed? And would you be okay with that?

Azuran

Funny, first rule of breech for my cousin was: C-section before labour starts.

Are you really that ignorant? What you just wrote there is that forceps or vacuum delivery is a RISK FACTOR FOR (i.e., potential cause of) shoulder dystocia. That is almost unbelievably ignorant. Operative delivery is an attempted SOLUTION to shoulder dystocia.

Amy Tuteur, MD

Actually forceps is a risk factor for shoulder dystocia and is not a treatment. The reason forceps is a risk factor is that they are often used in an attempt to deliver a baby who may be too big to fit. Forceps is not a treatment because forceps are only used to deliver the head.

Daleth

Oh, I see what you mean. Thanks. Still, isn’t it potentially misleading to say forceps are a risk factor? Generally, “X is a risk factor for Y” suggests causation: diabetes is a risk factor for SD because diabetes can make babies too big, previous SD is a risk factor because whatever caused the previous SD could simply be a feature of mom’s pelvis or her tendency to grow huge babies so it could easily recur, etc.

But operative delivery isn’t causative at all; in cases where it’s associated with SD, operative delivery is actually *being caused by* the excess size of the baby or the problematic shape of mom’s pelvis, right?

I guess I don’t like the “risk factor” phrasing because usually that phrase (1) suggests causation and (2) suggests a solution (i.e., if you have this risk factor, here are some preventive measures we should consider: elective CS, having an OR ready or having you labor in the OR in case an emergency CS is needed, etc.). But by the time you’re using forceps or a vacuum it’s too late to take any preventive measures.

Dr Kitty

Daleth, you’re jumping in too fast here.

Big head, may mean big shoulders.
A baby with a head that is too big to fit and needs forceps or vacuum to be delivered, has an increased risk of shoulder dystocia because once the head has been pulled out, it may be the case that the shoulders get stuck.

OVD is not a solution to SD, because forceps and vacuum only deliver the head, not the shoulders.

For once, in this specific thing, JB is correct.

Of course, in certain situations where SD *is predictable*, i.e. Women with DM, where the risk of shoulder dystocia approaches 10% (not 1%, 10%), it is reasonable to inform the woman of the risk, and that CS delivery reduces that particular risk to zero.

A recent UK case found that NOT advising women of the risks of SD, because you worry they will choose CS if you do is negligent malpractice.

But then it becomes much more complicated than the ‘forceps causes SD’.
If anything, the thing that caused the need for the instrumental delivery probably also cased the SD. Basically a huge baby that requires forceps to deliver the head is more likely to have bigger shoulder and have SD.
So then what exactly is Jacob advocating for?
Instrumental deliveries aren’t done routinely for fun. If you need instrumental delivery for the head, it seems unlikely that it’s going to pass any easier in the kind of natural birth that Jacob is recommending. And if it does end up passing, the baby still probably has a higher risk of SD regardless of how the head passed.
So then, should we just jump directly to C-section without every trying instrumental delivery?

So he’s basically saying ‘Avoid instrumental delivery because it raises risks of SD’ But that’s not being honest.

Dr Kitty

True.
It’s the relative CPD requiring OVD that’s the risk.

The solution is not to try to get women with big headed, big shouldered babies that have difficulty being delivered to deliver without instruments in water.

That just means a higher chance of a very prolonged second stage, a more compromised baby and having the SD underwater an hour or two later, instead of after forceps on a bed earlier.

SD is a bony impaction.
Relaxation, reiki, whalesong, acupuncture, homeopathy soft lights and someone knitting in a corner will not change the dimensions of a woman’s bony pelvis, because that isn’t how bones work.

Requiring induction or augmentation and prolonged first and second stage may be markers for a too big or badly positioned baby trying to get out of a too small or oddly shaped pelvis.
They are likely correlated with SD rather than causative factors.

Which means that all you get if you *don’t* augment is obstructed labour instead of SD, NOT an uncomplicated NVD like Jacob supposes.

Daleth

Thanks for educating me… now there’s a phrase you’ll never hear from Jacob Bunton and his ilk.

Azuran

‘In 25 years of attending homebirths I have had two’
That is such a bullshit and worthless thing to say.
Knowing how many emergency someone had in a certain time gives you no real information about the risk. It really depends on what kind of practice you have.
How many births a year does she do?
What are her risk out factors?
When does she transfer during labor?
How many transfer did she have? (and what happened to those transfer after they reached the hospital)
Basically, what she’s saying isn’t that birth is safe, more like, in 25 years, she failed to properly risk out or transfer someone twice. It is possible that those were totally unpredictable, and in that case, her patients are lucky that she was able to handle it.

Heidi

He is not even a bit consistent in what he’s arguing for. He thinks in the US we should offer water birth in the hospital because otherwise, a woman might choose homebirth. But you think homebirth is safer than hospital birth, Jacob, so what’s the big deal, huh?

Wants to use AMU, have waterbirth and physiological 3rd stage (birth placenta herself)

My colleagues said they wouldn’t have taken her.
Her risk was intermediate clinically and she also had social risk factors.

What about women’s choice?
What do we do? Abandon her? Force her?

I agreed to her using the AMU. I asked her about the baby’s movements several times throughout her labour, she told me baby was moving a lot.
I discussed her wishes for the birth of the placenta and explained increased risk of bleeding with an induction, and also Hb 98 and previous PPH 500ml, active management recommended. She understood the risks and wished to have a physiological 3rd stage. I explained if bleeding too much after birth I will have the injection of syntocinon 10 I.U ready (and also I had within reach cannula pack and catheter) just in case . The woman was happy to go to active management if needed.

I then let her be. Just listening to the fetal heart intermittedly with a sonic aid, immediately post contraction for a full minute every 15 minutes, and occasionally asking her about her baby’s movements. She immersed herself in the warm water and sighed a sigh of relief. She said ‘ah I love it’. She had her mother with her and though they had seen the room before for her first, they again both said how beautiful and relaxing it was and that the calm environment makes all the difference.

3 hours later she birthed her baby in the pool and had a physiological 3rd stage, birthing her placenta 10 mins later with an estimated blood loss of EBL 350ml. Her baby latched herself within 15 mins of the birth and though she had bottle fed her first she thought she’d give breastfeeding a go since baby had breastfed so easily.

Would it have been a different outcome if she had birthed on Labour ward?

This, my colleagues did agree on, replying ‘Absolutely!’

Charybdis

Would you have been so accommodating if she had asked for a CS?
And different isn’t necessarily “better”. You said your colleagues wouldn’t have taken her on, so….. why did you? You felt obligated to do so? Someone had to do it, so why not you? You felt you could manage a potential train wreck just fine, especially since the mother was amenable to some of the woo you favor?
This is where the hindsight is amazingly clear. Everything turned out just fine, but what if it hadn’t? What if there was shoulder dystocia? She was still in the tub of water…how would you get her out, or would you get in? Nuchal cord, knotted cord or short cord? What is the protocol for that while in a tub/pool of water? How do you get an accurate (or as accurate as estimates can be) measurement of blood loss in the water?
She just got lucky in the giving birth roulette, that’s all.

Sarah

Yeah, but she had a physiological 3rd stage and she’s breastfeeding. Those things are what really matters, let’s be honest.

Charybdis

That and the dim light and water. How silly of me.

maidmarian555

Did you ask this mother whether it was ok to spread her story all over the Internet? I can tell you’re keen to brag about how well it went but as a medical provider you have no business sharing the personal stories of others. If I found out my midwives were putting my birth story out there without my permission, I would be furious. It’s totally unprofessional.

Lilly de Lure

I really wouldn’t worry – judging by his other posts I’m guessing he’s as much a medical provider for actual labouring women as I am an astronaut. My money says he’s getting these stories from blog posts and/or his own imagination and his only experience of natural childbirth is watching youtube videos.

swbarnes2

And if things had gone horribly wrong, you would not be telling this story. You only tell the good stories. We care about the not-good stories. You would put them down the memory hole.

This is supposed to be meaningful how? Congrats, you told us how informed consent works- she knew the risks of what she chose to do (if you explained the risks of intermittent or no monitoring to her, at least), and chose to do it anyways.

How does this have anything at all to do with 1) how you would treat a woman who wanted a MRCS, 2) how much bullshit you’ve spewed to us about lights, cortical stimulation, pain relief, and so forth, and 3) whether this woman’s labor is at all meaningful for anyone else’s experience?

If she had bled out, if the baby had taken 10 hours and been born with severe hypoxia, would you still have shared this with us? Or would you have “forgotten” you presided over an avoidable disaster?

Dr Kitty

What was the Postnatal HB?

See, I don’t trust EBL in water, and if it’s under 80 she needs transfused.

You did check HB after delivery, didn’t you?

And pro-tip- if people can identify you and you location, and if you put out details like a para 1 delivering at your AMU on Wednesday just past, , well your patient may well be identifiable to people in your community. Not cool.

If you want to post anecdotes, you need to anonymise better or seek patient consent to post.
Do you not know this?

Dr Kitty

So…
Which is it?
No Postnatal HB?
Postnatal HB ok?
Postnatal HB not ok?
Or
Don’t know, don’t care, no longer my problem now she’s not in my unit and we “achieved” the magical warerbirth?

And if your response is “the AMU protocol is that we don’t do a Postnatal HB if the EBL is less than 500mls”-then that is evidence of negligence if you choose to apply it to a woman with an antepartum Hb of 98 and EBL in water.

Jacob Bunton

Thank you Dr Kitty for spelling out what we already know and practice. Hospital evidence based guidelines are there for a reason? Do you have any at your hospital? Or is it a free for all? Protocol was followed, FYI postnatal Hb normal.

Dr Kitty

Really?
Normal lower limit for HB in women is 115.
You said her baseline as 98 and she lost 350mls.
Where did the extra blood come from to get it above 115?

Or by “normal” do you mean “not low enough to require transfusion, just low enough to cause dizziness, fatigue and shortness of breath and to require oral iron for at least four weeks”?

Not the same thing.

Jacob Bunton

Would you prescribe iron tablets if a woman came to you in antenatal clinic without symptoms of anaemia and had a Hb below 115 but above 105?

The blood volume doubles in pregnancy so the iron level dilutes.

Also FYI Hospital guidelines were followed, women at this hospital are eligible to birth in midwife led unit with a Hb 85 and above.

A large British study, involving more than 150 000 pregnancies found that the highest average birth weight was in the group of women who had a haemoglobin concentration between 8.5 and 9.5.

What kind of different outcome are you talking about? Are you insinuating the baby would have been less well?

Or do you mean that your more cautious colleagues would have perhaps intervened differently from what you considered appropriate?

Just because you are okay with supporting patients to take risks doesn’t make you a better care provider.

This is classic process over outcome.

yugaya

Whoa what an unethical brag. I hope you are reported for this.

momofone

So you went against professional consensus and want to boast about the outcome because you see it as a reflection of your superior “knowing” and skill, rather than the pure dumb luck it was.

moto_librarian

I hope you are censured for this. Your grasp of confidentiality may be more limited than your understanding of birth itself.

Zizi

For a split second, I read the headline as “Sheena *Easton* and the Moral Bankruptcy of UK Midwifery.” Thank God I was mistaken.

Anyway, this is certainly a different picture than the one we Yanks get when we tune in to “Call the Midwife” on PBS.

demodocus

Well, Call the Midwife *is* set some 60 years ago. Most of us regulars and Dr. T herself were either kids or not yet twinkles in their parents’ eyes.

EmbraceYourInnerCrone

I am not British so I don’t know for sure, but during the post-WWII period that Call the Midwife is set weren’t all midwives required to be actual nurses/get their RN first? I don’t think that is the case any longer?

Mattie

Yep, it used to be a nursing training course (didn’t have to be a degree) and then an 18 month conversion. Now most midwives just do a 3 year midwifery degree.

EDIT: The 18 month conversion does still exist, although last I heard there was talk of phasing it out

EmbraceYourInnerCrone

I think that’s kind of a bad idea because shouldn’t they really understand more than just delivering babies? Lots of people have other health issues in addition to being pregnant and those affect their pregnancy, or pregnancy makes their other issues worse.

Mattie

Yes and no, midwives learn how to manage certain problems that might need alternative management in labour for example, but most women with complex medical needs alongside their pregnancy won’t be ‘midwife led’ they’ll be consultant led care or shared care, where their medical needs are being monitored by an OB and the pregnancy stuff (routine bloods, antenatal checks etc…) will be done by the midwife. Most places will have a series of protocols for managing common things like diabetes and pregnancy or heart conditions and pregnancy, which the midwives will learn. Anything too complex shouldn’t be dealt with by just the midwives.

Mattie

at least that’s what it was like where I was lol

mabelcruet

Strictly speaking, yes, that’s what should happen. Unfortunately there are some midwives who feel that they can cope with maternal conditions that should be risked out. In my experience, I’ve dealt with a number of stillbirths (as a paediatric pathologist) where, on review, the midwife either failed to recognise an emergent clinical issue or failed to assess the clinical situation and refer accordingly. This isn’t just me-this exact scenario has underpinned most of the recent inquiries like the one in Cumbria.

Certain midwives have a mind set that they can cope with anything, view referral to medical obstetrics as a ‘failure’ and consequently hold onto cases that they shouldn’t. I work with some amazing midwives and they are incredibly hard working, dedicated professionals. They are as horrified as I am about issues like Cumbria, but they are being badly let down by their college.

The Royal College of Midwives fails utterly to deal with this situation, instead pushing the mantra of normal birth as the be-all and end-all, rather than looking at why a small number of midwives develop this dangerous recklessness that risks tarring the profession. The behaviour of the Royal College of Midwives is abhorrent: hounding and bullying loss parents, refusing to accept the findings of independent enquiries, refusal to address the issues, and taking almost 10 years to investigate the behaviour and actions of midwives whose actions and inaction led directly to the needless death of infants.

Mattie

Oh yeh, absolutely! But unless we can prove that all the bad midwives are direct-entry then it’s not an issue of their training route, but of their own personal ideology. I’m not sure how we could ‘remove’ the potential students who have that harmful view, maybe some kind of psychometric test as part of the application process.

mabelcruet

I’ve got no answers. My impression from following the inquiry into Barrow-in-Furness was that the so called Musketeer midwives were all older and had been in post for years so it’s likely they were nurse trained first. I don’t know how much of the ill placed confidence is personal ideology, and how much is embedded in their training, or how much is facilitated by RCM leaders bleating about midwives being the guardian of natural births but becoming strangely silent about deaths, both maternal and infant (as Dr Tuteur keeps saying-valuing process over outcome). I strongly suspect that we are only beginning to see the full impact of this ideology with clusters of baby deaths being reported in Shrewsbury and Telford, Kilmarnock, Caithness, Homerton in London, and Oldham. There’s bound to be others.

mabelcruet

The Kirkup report into Cumbria was very detailed about the culture on the unit concerned. In the NHS in general there is a bullying culture-whistleblowing isn’t supported by management and it can be extremely difficult raising concerns, even though technically there are are whistleblowing policies. There was a small group of dominant midwives who overrode everyone else. It’s well known that any clinician raising concerns gets bullied, harassed, even driven out of post. It was reported that other staff in the unit were concerned but weren’t supported in raising those concerns. The report said that the behaviour of the dominant group was such that other staff were too frightened to complain-I’d imagine that raising concerns would have resulted in them getting bullied and picked on and their daily working life made a misery.

We’re always been told that the behaviour of the airline industry is what we should be aiming for-an open and transparent culture where mistakes and incidents are investigated without ascribing blame and all staff are encouraged to report issues. They also make sure that personnel rotate frequently-in the NHS people may stay in the same unit for years and that leads to staff becoming more loyal to their team rather than to the service or patients, and that led to cover-ups in Cumbria where all the midwives covered for each other.

Mattie

Completely! There’s horrendous bullying within healthcare, and midwives seem to be the worst for it. It’s awful, but it means that students who don’t ‘fall in line’ will quite often leave due to the stress, which means that the new midwives are just fulfilling the roles already present 🙁 I don’t know what the answer is, but there definitely needs to be change.

mabelcruet

Absolutely-there’s been review after review about bullying in the NHS, multiple protocols and processes designed to reduce bullying and improve working relationships but nothing changes. It is down to the individuals in a department and the leadership and management exhibited in each dept, but the NHS on the whole can be a toxic environment. There is an assumption that bullying is hierarchical and can only be ‘top down’ but some of the worst bullying I’ve seen has been bottom-up, where mobbing occurs and a group of staff gang up against a perceived incomer or outsider, like a newly appointed supervisor for example, or someone not part of their ‘tribe’, like midwives against junior doctors.

When you have that sort of gang mentality, where your acceptance in the work place is conditional on you taking on the behaviour of the dominant group, you get drawn rapidly into a downward spiralling culture of bullying, harassment, belittling and undermining behaviour. And that leads to a situation where clinical care becomes secondary-your loyalty is to your gang, not to patient care or safety, and that’s what happened in Cumbria. A dominant group decided they knew best and overrode everyone else, and bullied others into complying.

Mattie

Yeh, it’s horrible, and it’s scary as a potential mother-to-be because you don’t know what the culture is like until you’re in it.

mabelcruet

Midwives in the UK used to be trained as nurses first, but there are now direct-entry midwifery programmes with no prior nursing qualification. My personal view is that this is short-sighted. Mothers are getting older and with age they are becoming increasingly unhealthy. I think that a background in general nursing would help when they are facing a mother with underlying medical conditions.

True story-one of my friends was training to be a GP (family doctor), and he spent 6 months in obstetrics as part of that. He was called to see a labouring woman as things weren’t progressing quickly and mum had had quite a bit of bleeding. He came to assess the woman, and asked the midwife to check her pulse. The midwife put the Pinard on the mothers wrist….

Mattie

omg… that’s ridiculous! Basic obs was like our first clinical skills session in the first month of year 1!

Zizi

Ah, now I see. It’s a bit easy to forget that they were all nurses when you’re caught up in the drama.

Also, during the first season or two, PBS used to run the occasional brief spiel for midwifery (this clip was directly imported from the UK, I think) and how wonderful and safe it really is. I watched it and thought, “Wow, I didn’t know that.” Stumbling on this blog has shown me a very, very, very different side of things.

Tigger_the_Wing

Certainly, when my mother and I were having our children (between us, every decade from the fifties to the nineties) that was the case. Fully qualified nurses adding midwifery to their skills.

I thought it still was the case – and am horrified that it isn’t.

Sarah

Some of our parents weren’t twinkles in their parents eyes then!

sdsures

I can’t watch that show. Drives me nuts, right down to the institutionalized racism.

momofone

I don’t know; Sheena Easton might do a better job than many of the midwives currently working. 🙂

The Bofa on the Sofa

Strut, pout, put it out, that’s what midwives want from women?

On the morning train.

Zizi

Love both of those songs.

The Bofa on the Sofa

The Strut video is awesome.

Zizi

I agree.

PeggySue

Completely OT, but I just learned that the annoying essential oil diffuser that was placed in a common work area where I work is actually part of a wonderful new Innovation proposed by staff to reduce employee stress. I am an asthmatic. This is not reducing my stress. What is REALLY not reducing my stress is that I work for a health care provider, the Innovations that people are proposing and implementing willy-nilly are all supposed to be evidence-based, and yet this idiocy has been put in place with no notice to employees. In vain have I said, there is a difference between Evidence and GOOD evidence. Has anyone ever found ANY reputable evidence for the efficacy of aromatherapy? ANY? I am steaming AND wheezing. Though given that they just went BFHI I should not be surprised.

Roadstergal

We recently stayed at a B&B where they put little bags of lavender potpourri under the pillows. We took them out, but it was still awful to sleep.
I’m lucky that my work is, if not an official perfume-free zone, at least a tacit one. I would think the allergy issue would be enough to take the new development to HR?

FormerPhysicist

Yeah, that’d make a great workmen’s comp claim. Make an official written complaint and keep a copy. Just in case.

kfunk937

My workplace was officially a perfume-free one also. An unexpected exception arose with a code brown in an OR when the deodoriser wasn’t neutral. The perfume set off an asthma attack with the albuterol several floors away in a desk drawer. I also encountered perfumes occasionally when people are called into work on short notice.

I join in on the lavender scent hate-wagon, although the flowers are nice. Outside.

sdsures

I hate lavender, too! (asthmatic here)

demodocus

Can you talk to who ever’s in charge of this one and remind them that unless they want to pay for -more- asthma meds and possibly a hospital stay for an attack they they really shouldn’t have these any where near you? It’d piss me off too. I -hate- aromatherapy, because I’m allergic to some perfumes and when I was pregnant I could smell everything and it’d make me sick to my stomach.

Young CC Prof

The person who placed it is probably unreachable, because they think EOs are magic and can’t possibly be harmful, but you could try asking them to remove it.

If that doesn’t work, go over their head or to HR. If this is a space where patients are, I guarantee there are patients who are upset about it, too.

As for evidence, there’s no evidence that aromatherapy cures anything. If you happen to like the scent and not be allergic to it, it may relax you, but that tiny benefit is far outweighed by the harm to people who are sensitive or simply dislike it.

PeggySue

Thanks all. Yeah, I didn’t think there was any *real* evidence that aromatherapy was beneficial, but as Young CC Prof has pointed out, that will not matter to those in favor. I am weighing my options. It just seems like a health care provider would catch some of these obvious woo incursions, although, as I said, since they have gone BFHI, I should expect anything and everything. Some of you have been around long enough to remember the story of a woo-infested RN who did a “study” of the efficacy of aromatherapy for symptom management on our hospice acute care unit. There were some problems with controls–the doctors tended to come round and add fentanyl between the time the AromaRing was placed and the patient was “monitored,” but hey, what’s a little confounding between friends? I think she genuinely felt she was helping the patients, which terrified me, because at the end of my life, if I am having pain, I would way rather have fentanyl than aromatherapy.

Heidi

Did she at least ask permission? Ugh, the last thing I’d want is for my environment to smell like a health food store.

PeggySue

Oh, yes, she was scrupulous about that part, though perhaps overoptimistic in her assessment of potential benefit. The lack of control for other treatment interventions was a bit troubling to me, but then I am very picky about these things. My great fear is that I will end up in a hospice filled with woo, and I will have 5 white suburban housewives who think they are shamans rattling bones around my bed when what I need is an opiate infusion.

Heidi

When we end up with a “natural hospice” movement, all I can say is that will be the moment nothing in this world makes sense to me.

kilda

I think the one reason that won’t happen is that the woo types never admit anyone is dying. They can all be saved by eating the right herbs or avoiding gluten or detoxing or what have you. So instead of sending people to a “natural hospice” full of ineffective natural treatments, they put them through a bunch of ineffective natural treatments meant to cure them.

Come to think of it, the result for the patient is pretty much the same.

There is much more woo in hospice than you would like to know. No one likes randomness and no one likes suffering, but woo-types also don’t like medication, and so you have all kinds of romance about Caring for the Dying that is total crap. You get folks who are certified Thanatologists who are taught that there are certain patterns of music played on the harp that can ease transition and stress, for instance, and don’t get me started on the Death Doula movement. I can tell you that unmanaged terminal delirium is hell for the patient and the family and everyone around, and you can do all the Therapeutic Touch and Reiki you want, but it won’t do a bloody thing. I think I, along with some very good doctors, have helped educate some nurses that “spiritual distress” is not really the cause of delirium when someone is encephalopathic, with lytes in a range incompatible with life, and uncontrolled pain. Drugs, baby, drugs.

Heidi

Jeez, death doula? I googled this and it seems like a money making scheme. You can volunteer at a hospital and get trained for free! The hospitals I’ve worked at will let volunteer where ​they want and throw in a free lunch.

demodocus

I’m fairly sure that if someone tried any sort of faith healing on me while in hospice, I’d manage to convince them I’m possessed. Ugh.

Amy Tuteur, MD

How dare anyone try to interfere with UK midwives belief that process is more important than whether babies live or die?

I suspect that soon the Nursing and Midwifery Council will be calling the Health Secretary Jeremy Hunt the same thing that radio newscaster James Naughtie accidentally did back in 2010!

PeggySue

the HELL? Not proportionate? We are talking about LIVES here. Against a training requirement? The risk has been amply demonstrated, sadly, and the solution made crystal clear. This is just immoral.

Merrie

Slightly OT, but I’m curious if the antibody transmission from mother to baby (in pregnancy or via breastmilk) is the same for immunity caused by an actual case of the disease vs immunity from a vaccine. This occurred to me because I realized that the first batch of kids to get the chicken pox vaccine as young ‘uns are now old enough to be having their own babies, and this could be measured. I myself was exposed to the chicken pox right before the news came out about the chicken pox vaccine. I was pretty ticked off about that… if the epidemic sweeping our elementary school could just have held off another couple months!

Young CC Prof

That’s a really good question.

If the mother is strongly immune, it doesn’t matter whether the immunity came from infection or vaccine, because either way, she has antigen-specific IgG circulating in her bloodstream, which will be pushed across the placenta during the third trimester. (Human breast milk doesn’t contain any antigen-specific antibodies, although other species do, mostly species that are less efficient at transferring antibodies before birth.)

There is some evidence that for measles, maternal immunity from naturally infected mothers lasts a little longer than maternal immunity from vaccinated mothers, because naturally infected measles survivors tend to have higher antibody levels in the bloodstream than vaccinated people. Of course, if you’re in a community where not only children but women of childbearing age were mostly vaccinated rather than infected, the disease SHOULD be out of circulation, unless all those women decided to get historical amnesia and not vaccinate their own kids, not that anyone would ever do a dumbass thing like that.

Then of course, the killed vaccines TDAP and seasonal flu can be given during pregnancy! When they are, especially in the third trimester, babies are born with high levels of maternal antibodies. For flu, we also have tons of epidemiological data showing that this works, for pertussis, fortunately neonatal pertussis is rare enough that we only have laboratory evidence that it works as far as I’ve seen.

Merrie

Thanks. I think I kind of suspected that. I’m 31 weeks pregnant and just got my Tdap shot a few days ago. I am glad I was able to get it. I got the flu shot in the fall before I was pregnant, so hopefully I’ve still got some pretty good immunity hanging around from that. But it does bum me out that the MMR and V are all live vaccines, can’t be given during pregnancy for this booster effect, and can’t be given to the baby until 1 year of age, so you just have to hope you were immune before pregnancy and that the antibodies stick around in the baby until they can get their own shot. I guess that is why they advise you to have a preconception checkup and have titers drawn, but how many people actually do that? I wonder if someday checking MMRV titers will be a routine thing to be done every X many years in adult primary care.

AnnaPDE

“Who gets these?”
I couldn’t talk my Aussie GP out of checking those titers even though I already had results from my German OB/Gyn who ordered the tests (and a bunch more) when she pulled my IUD. Actually she had discovered that my iron ws way too low I was only at the GP for some additional checks before getting IV iron, but he decided to throw in the tests as they were no out of pocket coat for me and a useful data point on my electronic record.
I’m glad to have access to this kind of routine medical care.

Heidi

I know at my first appointment at 7 weeks MMR titers were drawn. I didn’t have to request it or anything. I skipped a preconception appointment but in the US I think MMR titers are routine for those. Unfortunately here you just need health insurance and a way to get to the doctor to actually get prenatal care.

Young CC Prof

Checking titers at the first prenatal visit is good. Problem is, if they find you aren’t immune, it’s too late to do anything about it and you just get to worry for the next 8 (or 20) months. If we checked titers before conception, you could get a booster shot.

Heidi

Yes. They are offered preconception too if you follow the advice and get a preconception appointment. But with unintentional pregnancy or like me, just being unaware of the MMR titers thing until after the fact, I figure it gets drawn too late too often to do anything if it’s not optimal.

Azuran

I don’t know if it still works that way, but when I was a kid, titers were also used to assess working risks. A pregnant teacher who was found to not be immune to rubella would be put on preventive leave, for example.

DrSelina

Not rare anymore, unfortunately. Oregon, Washington, and Texas have all had neonatal pertussis outbreaks in the past 5 years. It is one of the reasons why we are vaccinating all pregnant moms at 28 weeks.

Roadstergal

“There is some evidence that for measles, maternal immunity from naturally infected mothers lasts a little longer than maternal immunity from vaccinated mothers, because naturally infected measles survivors tend to have higher antibody levels in the bloodstream than vaccinated people.”

And of course, that’s correlation vs causation – it’s not that you’re better off getting the disease, it’s that the disease will best kill off those who don’t make a robust response…

Mattie

Is it worth paying for boosters of TDAP/MMR before TTC, I will be doing IVF/IUI so am fortunate in that I can control when I do it, my last TDAP was like 11 years ago and my MMR was when I was a child :/

demodocus

You’re due for a TDaP anyway, so if your IVF is still a ways away you should, if you’re starting next week, Im not sure I’d bother, since they’ll want you to get another one around the start of your 3rd trimester.

Odds are you don’t need the MMR, and i don’t think they offer it during pregnancy either way.

Ask your ob. 🙂
Good luck! I’ve done the IVF routine too

Mattie

we don’t get offered 10 yearly TDaP 🙁 Just wondering if it’s worth getting the MMR booster pre-conception, to make sure that I/my baby have as high immunity as possible, as I can’t get an MMR in pregnancy and my baby wouldn’t be able to get it until 1, so making the most of that cross-placental immunity. If I get a free TDaP in pregnancy I’m reluctant to pay another one now (unless it’s super necessary). The baby-making won’t be happening for at least 2 years so a ways away atm, but I like to plan.

demodocus

From what I understand, getting anything pre-pregnancy won’t really help your baby any more than your co-parent (if any) or grandparents getting it. You cannot pass it on, but they don’t really get much immunity.
MIL got rubella in her first trimester with my husband, but he was vulnerable to rubella as soon as he was born anyway, because his immune system wasn’t operational when they got it and her passive immunity after that didn’t protect him any more directly than his dad’s immunity did.
Dr. T mentions all over the place that breastfeeding prevents 1 fewer cold and 1 fewer case of diarrhea overall. Breastmilk’s protections are really over sold.
MMR doesn’t usually need a top off, but if you are concerned, talk to your docs.

Mattie

Ok 🙂 I was just going by what was said down-thread, like how checking MMR titers in pregnancy is pretty pointless as you can’t get the MMR while pregnant, so it’s better to check them before conception and get a booster then, and also how measles immunity reduces as time goes by so isn’t as good at providing passive immunity (via placenta). I mean, that’s why they give the TDaP in pregnancy right? To protect the baby before it can be vaccinated?

Young CC Prof

Any disease to which you are strongly immune before pregnancy, you pass on antibodies during the last weeks of pregnancy. They eventually break down in the baby’s body, but they help get the baby through the newborn period until his own immune system starts working.

With TDAP, the fundamental problem is that the acellular pertussis component doesn’t work terribly well. Better than nothing, but not as strong as it could be, and nowhere near as strong as the old vaccine. So, conferring strong maternal immunity apparently requires the initial antibody surge from the vaccine to occur during the third trimester.

With measles, though, even women vaccinated decades before pass along meaningful levels of maternal antibodies, as long as they are still immune.

And yeah, this is all prenatal. Human milk, unlike that of some other animals, does not contain useful quantities of antigen-specific IgG.

Amazed

“Go! For like the sun is knowledge.
On the soul it sheds its rays.”

I’ve always found those words very meaningful. I do find the glorification of insufficient knowledge that leads to pretend everything is normal very disturbing. For all midwives’ shouts of enlightment, their souls look remarkably unlit to me. Is it a coincidence that they’re also lacking in knowledge?

Dr Kitty

OT:
Involved in s discussion in a local GP group about maternity care.
The general feedback is that maternity care is great if you want (or get) an uncomplicated SNVD and breastfeed easily- otherwise it is patetnalistic, condescending, negligent, potentially unsafe and unpleasant. This is from GPs who are parents as well as doctors, speaking about personal experience as well as the experience of their patients.

Abby

I completely concur with this! I’m a British GP and a mother of one ( for a reason, I literally cannot ever go through that again and my labour care was great, just a horrendous experience but the antenatal and postnatal care was awful/ non existent ) I think it is a combination of an extension of the attitude to women’s pain in general, that is belittled and under treated routinely in hospital, and the fact that a lot of uk midwives seem to really hate pregnant women, everything is a hassle for them, ‘my babies not moving’ ‘I think I’m in labour’ etc results in an eye roll ‘neurotic over reacting silly women’… this may explain our awful still birth rate..
I know they are over worked and under staffed and there are some wonderful kind midwives out there who I’ve worked with and who looked after me for the really important bit of getting my child out alive. ( plus a wonderful wonderful obstetric registrar) but I’m a GP and I would never get away with being as dismissive and arrogant towards my patients as the midwives can be towards theirs.

Mattie

That’s so sad 🙁 I’m so sorry

demodocus

Jaysus. *hugs*

PeggySue

That’s awful. I suppose anything other than rapturous smiles on the part of the patient threatens their romanticism about birth. But good heavens. “With woman?” Not so much.

FedUpWithYourBS

I feel sorry for that tiny mind of yours rattling around in your head like a pea in a whistle.

Who?

Save it for Sheena Byrom’s victims.

Sarah

I feel sorry for your face.

momofone

Hi, Sheena.

Amazed

OT: I was invited at a friend’s house. Yesterday, the visit was postponed. I am no longer welcome because her grandson has the chickenpox and I have not had it. The kid immediately told his grandmother, “Tell Amazed not to come before I am back to health!”

He’s five and he gets it. He knows that getting ill or getting someone else ill is undesirable. Oh and he’s responsible as well because we’re good friends and he really loves seeing me. In fact, he’s the one who always tells his grandmother to invite me when he’s over there. But not when he might infect me. Just how many levels does this elevate him above MAM, Dr Sears and the likes?

maidmarian555

I wish one of the women who runs the toddler group I attend with my son had this attitude. She didn’t tell anyone she’d inadvertently brought along her infected daughter (and I understand how that might happen if you didn’t know as the first day they may have one or two spots) until two weeks later when suddenly a whole load of the children broke out in blisters (including my son). Luckily both I and the other pregnant woman who regularly bring our children along have already had it. To say I was really unimpressed would probably be understatement of the year. Because it isn’t part of the vaccination program here, people think it’s genuinely ‘nothing to worry about’ and tend to automatically assume everyone has already had it. She also told everyone her doctor was ‘really surprised’ her breastfeeding infant also caught it as apparently breastfeeding babies ‘aren’t supposed to able to catch it’. My eyes rolled so hard they almost fell out the back of my head……

kilda

but breastfeeding babies are protected from all illnesses by the magical breastmilk! that’s why in the olden days babies never ever died before the age of one.

Dr Kitty

If someone calls to say they think their child had chicken pox, I ask if they have fluid filled blisters and where they are and if the child’s granny thinks it is chickenpox. No other rash really looks like it- if granny thinks it is chicken pox and the child has fluid filled blisters on their limbs, torso or face- that is what it is.
I don’t need to see well children with chicken pox, and I want sick kids with chicken pox seen at the start or end of a surgery, to sit in the parental car until I can see them and to spend as little time as possible in my waiting room.

And yet, there will still be parents who get same day, emergency GP appointments for their child with “a rash”, when the child is well, they’re 90% sure it is chicken pox but they just want a GP to say for sure…after the kid has been in the waiting room for 30minutes.

If you think your child has chicken pox, even if you aren’t sure, they should not leave your home until all the spots are scabbed over. If you think they require urgent medical attention, you should discuss it with a Dr so that arrangements can be made to reduce the risks to others. This is not rocket science.

BeatriceC

In a similar vein, the hospital had me do something similar with my oldest the second time he got pertussis. He’s a non-seroconverter, so he’s gotten it a couple times even though he’s gotten the shot three times since 2012. Anyway, He was doing rather poorly and needed medical intervention. I called ahead to the ER (because turning blue is a sign that emergency medial attention is required), and they had somebody waiting out front with a mask and gown for him, put them on (gown over his clothes) and whisked him back to the room they have set up for highly contagious kids (negative pressure, I think they call it). They did not want him waiting one second in the waiting room, since I was 90% sure that’s what it was, but he clearly needed help breathing, so I had to bring him in. They were glad of the heads up. It helped them protect the babies who couldn’t be vaccinated. Now if only other people were so nice to people who aren’t protected by vaccines through no fault of their own.

Tigger_the_Wing

My eldest and I also have trouble seroconverting for pertussis, so I feel for you. It’s a horrible disease.

KeeperOfTheBooks

I freaking HATE chicken pox.
My idiot mother decided not to vaccinate me because CP is “no big deal” and somethingsomethingsomething aborted fetal cells vaccine something. I had a quite unpleasant case at 7 years old, and then a full-blown HORRIBLE case at 13. Hallucinating, pox everywhere…it was, hands-down, one of the most awful experiences of my life. I remember wrapping my head in a blanket because my face was entirely covered in pox, and I was sure I would go completely insane if I touched my face one more time and felt all of them. I remember sobbing hysterically because I couldn’t bear the feel of the pox or the smell of them, plus, of course, I was running one hell of a fever. Then getting sent back to “school”–a homeschool co-op held, in all places, in the basement of a nursing home–a couple of days later when I still felt like the dog’s breakfast, and being expected to concentrate on algebra while the room kept whirling around…
Suffice to say that when the ped lets me know that one of the kids is getting vaccinated for CP at a well-child visit, I practically jump for joy at the thought.

Amazed

Hmm, how long does this protection last? I mean, I was fully breastfed. Surely that should protect me? Do you think I can go over there tomorrow?

maidmarian555

You really don’t want chicken pox as an adult. I had it at 16 and it was horrible. A friend of mine had it in his twenties and was hospitalised. And that’s the thing that annoyed me really, it’s not her fault that she didn’t know her child was infectious- the first I noticed my son might have it was due to a single blister on his back when I gave him his evening bath. But she *should* have let everyone know right away and not fail to say anything until other children got sick. She doesn’t know that all the other parents have had it, she doesn’t know whether any of those children have sick relatives that really shouldn’t be exposed to it. She doesn’t know whether any of those children have other conditions that mean that getting chicken pox could be bad for them. If people know they’ve possibly been exposed then they can get medical advice *before* it becomes a problem or take proactive steps to avoid at-risk relatives and friends until enough time has passed to be sure they don’t have it. But then I guess if you live in a bubble where only you and yours matter then you don’t have to consider that perhaps other people’s circumstances might be different. I would be much better at doing the whole trying to make new mum friends if they weren’t such inconsiderate assholes.

Amazed

A doctor neighbour of my mum’s was very upset because a patient of hers, around 40, actually got permanent lung damage from chicken pox. Lung damage!

It isn’t anyone’s fault for failing to realize her kid was infectious but knowing it and not bothering to inform people who might have a good deal at the stake is beyond reprehensible. With all that reading new mothers do, they somehow fail to notice anything that might get them inconvenienced?

BeatriceC

Years ago, I think around 2008 or so, a colleague of mine at the community college where I taught went to Disney World with his family, including his 70-something year old mother. They came home with the chicken pox. His mother isn’t a US resident (none of them are US citizens, though half the family does live in the US), but she got stuck here for weeks, because, while a 40-something year old man with the chicken pox is scary, a 70-something year old woman with the chicken pox is downright terrifying. Unfortunately, her medical insurance from her home country wasn’t valid in the US, so the family was then stuck with extraordinary medical bills from their mother’s treatment. Thankfully she turned out fine, but if anti-vaxxers weren’t a thing, none of that would have happened.

Last news on the vaccine front: a kid Amazing Niece used to play with has just come down with the whooping cough. SIL can only repeat, “It’s the 21st century, FFS! Who gets the whooping cough in the 21st century?” Of course, she knows who. Needless to say, Amazing Niece will no longer play with this unvaccinated by choice kid. Thank God she got her shots!

They truly don’t help it, do they? The thing is, kids like yours wouldn’t be getting the whooping cough if everyone who could get the vaccine for their kids did get it. But anti-vax parents probably think like SIL, “Well, who gets the whooping cough nowadays?” The difference is, she knows the majority of people don’t get it because of shots. Anti-vaxxers seem to think the centry is magical or something.

maidmarian555

Oh no, poor kid! One would hope that it might make the parents rethink if they didn’t vaccinate on purpose, whooping cough is really nasty. Have to say I’m like your SIL though, I wouldn’t let my child play with unvaccinated-by-choice children either. He may have had his shots but that doesn’t mean he definitely can’t catch any of these horrible illnesses and I wouldn’t take that risk.

Sue

“they are worried about practising as qualified midwives, as, during their training, they hardly ever see women who have had a normal, physiological, straightforward pregnancy, labour and birth”

Why don’t they get it? Those uncomplicated, straightforward ones deliver themselves…..it’s the complicated ones that they need skilled providers for.

Either childbirth is the most natural, easy thing in the world, in which case you don’t need a skilled birth attendant at all, or it’s not, in which case you DO need a highly skilled provider. Which is it?

Karen in SC

I thought that “complaint” was more like “things that never happened.” Plenty of women give birth without intervention in the hospital, they are sensible enough to realize they need to be in the hospital just in case. I did so twice.

demodocus

Mom did so 4 or 6 times (depending on whether you want to count the triplets separately)

Amazed

“They tell me they are worried about practising as qualified midwives,
as, during their training, they hardly ever see women who have had a
normal, physiological, straightforward pregnancy, labour and birth.”

Yeah, that’s what I thought about Sheena. She doesn’t mind a woman normally, phyciologically, straightforwardly fail to push out her baby’s too ibg/malpositioned head, fail to have her uterus contract, fail to stop bleeding, fail to, fail to, fail to. Because as long as it’s uninterrupted, especially when needed, it’s GOOD. No matter the outcome!

fiftyfifty1

“they hardly ever see women who have had a normal, physiological, straightforward pregnancy, labour and birth.”

Yeah, so many things wrong with this:

1. I don’t for a minute believe it. During my training I saw these births right and left. If nothing else there are always low risk multips that come in far advanced in labor. But during my training I also saw first time moms with zero interventions. They are lying.

2. If they aren’t lying, this is super scary because it means that their volumes must be really, REALLY low. What are they seeing, like 8 births total?

3. Even if they did have high volume, and did (somehow!) never see a straightforward easy birth, so what? Straightforward, easy births are straightforward and easy. You barely have to do a damn thing other than sign the birth certificate. Any first year medical student, or monkey, or cabbie, or 6 year old can deliver a straightforward, easy birth. Or a mother can do it unassisted. It’s the complicated ones that you need to learn skills for, not the uncomplicated ones.

Melaniexxxx

Yes!! This!
Even as a medical student, let alone a junior doctor, i’ve seen plenty of deliveries/births with nothing more than IA.

If they haven’t, they’re either horrifically lazy or their training is woefully inadequate,

But, again, as you say… why the NEED to see all these ‘amazing brave’ type births? They don’t have to do anything for them, barely BE there, so again… laziness? Not wanting to take responsibility? Having no confidence in their ability to ACTUALLY help a labouring mother if something goes wrong?

Dr Kitty

It’s because high risk obstetrics and complicated L&D is not fun for them.

THEY feel like failures if the woman doesn’t “achieve” a intervention-free, uncomplicated spontaneous delivery.

They don’t get to say that their special midwife skills allowed mum to forgo analgesia, deliver quickly and painlessly over an intact perineum and experience a near-religious ecstasy during the birth.

If there has been a massive PPH or a bad shoulder dystocia, no-one has the time or energy in the aftermath to sing the praises of their midwife, the way they do if everything is straightforward and unproblematic.

They have to admit that despite all the midwifery skills and training and intuition sh*t still happens, and the patients just don’t realise how bad that makes them feel.

It makes the midwives feel sad when complications happen.
So they think it should make women feel sad too.

Poor midwives, never having the experience of a “normal physiological birth”.
We’re just not getting how awful that is for them.

mabelcruet

One of the funniest things I ever watched on TV was an episode of a midwifery/hospital birth series (it could have been ‘One born every minute’). Woman was labouring and was being cared for by midwife who had a trainee midwife with her. The baby in distress, decision made for emergent section under GA. Huge team descends onto the ward-neonatologists senior and junior, neonatal nurse practitioner, obstetrician, anaesthetic staff-the usual suspects. As the camera filmed the woman being wheeled into the theatre, the midwife and trainee were being interviewed. And she said ‘this is the scariest part of midwifery. The baby’s life is in the balance, and I’m the only person there with the skills and training to resuscitate the baby, everyone is depending on me’. Er, no.

Gæst

I don’t care what any midwives say* – my pre-eclamptic, hypothyroid, induced, premature, urgent c-section birth was just as “normal” as any other kind. I was a human mother and gave birth to two human babies. Normal is as normal does.

* I used midwives, actually. They never pulled this “normal” or “natural” language nonsense on me.

I saw a few babies in the NICU who had “normal” births that went badly wrong.

Thankfully, they were in a hospital so the babies and moms survived and did great – but you can’t get me to believe that women who were visiting the NICU in a wheelchair with donut cushions on the seat and who were walking gingerly for weeks(!?!?) after their babies were born had a better birth experience since they had a “normal, physiological and straightforward pregnancy and birth” than I did with an urgent pre-term CS.

Krista

The birth of my second child was normal until it suddenly wasn’t. Right at the end the monitors indicated the baby had gone into sudden distress. No one knew why at the time, but they used vacuum assist to get her out quickly. It was all over in a couple of minutes, cord cut and baby recovered. It turns out there was a knot in the umbilical cord that had suddenly pulled tight in the final stages of labour.

I’m pretty glad they didn’t just take a wait and see approach, don’t worry we’re sure it’ll all turn out fine if we just leave things be. Because maybe instead of a healthy 4-year old, I might have ended up with one of those “the baby was born unexpectedly sleeping” stories instead. So yeah, science for the win on that one.

Tigger_the_Wing

I’m delighted the intervention was successful. The birth of my second son was normal until suddenly a pair of legs appeared. I’d felt him as he somersaulted overnight (I was already in hospital) but the midwife decided not to believe me, rather preferring to go by what the obstetrician had written in my notes earlier the previous evening, about his head being engaged. Eighth-month fœtuses shouldn’t be somersaulting; but I have EDS, so mine have always been mobile. Cue emergency forceps delivery; no time for any pain relief.

He’s now a healthy 34-year-old, with two sons of his own.

Ten years later, I had twins; twin one having been delivered, twin two went swimming and stopped when he was lying sideways. The obstetrician decided to see if they could turn him first, before going for a CS. He was also born breech, but because I’d had an epidural this time, and his large-headed twin had already opened things up, he slid out without any problem.

Jacob Bunton

I agree

Deewhybaby

I’m a Brit living in Australia and I’m so glad I had my baby in here in Sydney. I’ve watched a doco series on a British labour ward and there was countless times of a women screaming for pain relief and being told she couldn’t have it or didn’t need it. There was one incident where an second time mum was screaming that it was so much worse than the first and the midwife basically told her she was overreacting and denied her an epidural. Turned out it was a back to back labour that the midwife hadn’t picked up. She just shrugged.
I’m not sure if it’s short staffing, money saving or ideological but it is terrifying. The majority of Brits use the NHS and have no choice about the care they get, private health insurance is for the top 1%.

Sue

And by the beach, too! 🙂

I have no doubt that there are some woo-driven midwives in Aus labour wards too, but our system seems to be more amenable to choice than many other national health systems.

The NHS is very good at containing costs but, some would say, at the expense of choice.

Sarah

I would say they are also usually good when the shit hits the fan: not always, but usually. It’s before things get to that stage that can be a problem. My relatively normal labour saw me receive much worse care than my very emergency section and SCBU for baby, which was exemplary.

Deewhybaby

I’d agree with this for other areas of medicine too, with the NHS.

Sarah

Not that a diagnosed back to back labour necessarily gets you an epidural in the UK anyway.

Azuran

Seriously? They actually refuse to give epidural to women who wants them?
I can understand that sometime there are emergency so no anesthesiologist is availlable, or in case of very fast labour where the baby is already half way out. But how can they seriously refuse women epidural for no reason?

Sarah

Dunno, ask the midwife that was looking after me while I was going through transition and didn’t bother contacting an anaesthetist despite my very, very frequent requests. By the time they did get one, I was 10cm. I also couldn’t have any more diamorphine.

blargh

Diamorphine doesn’t even exist in the US, because it’s heroin. And since that is a scary word, we don’t have it.

Sarah

Plus you don’t have the anything but an epidural mindset that we do.

Young CC Prof

There’s plenty of anti-epidural sentiment in the USA, but most of it is not coming from medical professionals who have the power to prevent you from getting one. If you ask for it in a timely fashion, in most hospitals under most circumstances, you get it.

Mattie

Do you guys only have epidural then? Or gas and air, and epidural?

Heidi

I think it all depends on what hospital you choose. My hospital offered an epidural, IV pain meds, or local anesthesia. Not sure if gas was offered. They no longer offered walking epidurals because of lack of demand.

Mattie

Cool 🙂 I dunno if I’d want IV pain meds, and it’s super likely that local anaesthetic and epidural won’t work all that well on me (yay for chronic condition) so I’m glad we have gas and air here, it works really well for me haha I think it has to be about choice, as well as cost, women should have the choice of multiple good and safe options in birth

Jacob Bunton

That’s a shame no longer offer walking epidurals. Means more intervention – forceps or suction cap to baby’s head(vacuum), and surgical cut to perineum (episiotomy). Harder to push when your legs are deadweights and you in a semi-recumbent position. Easier when on all fours, or upper body resting over back of bed -opens up the pelvis.

Heidi

They don’t offer them because WOMEN who were the ones birthing didn’t want them. They don’t give a crap what Jacob Bunton wants. Episiotomies are not routine these days. I had an epidural and popped that baby right out with no episiotomy, suction or forceps. I could easily focus on pushing when I wasn’t in pain. Yes, I would much rather not be able to move my legs for a few hours than feel what I had to feel before the epidural worked. The nurse and my husband held my legs for me so it worked quite nicely. You are so incredibly sexist.

Jacob Bunton

Given that an epidural increases the risk of an instrumental delivery by 5 x which also carries the risk of an episiotomy, or severe perineal trauma then a walking epidural would probably counteract that risk, given being on all fours or a semi-upright position you are more likely to have a spontaneous birth.

Citations please … because I can think of at least one anecdote that counters that (and yes, I am aware that anecdotes are not data). My mom had back labor, and failed to progress until she got an epidural that allowed her to relax enough that she continued dilating. That epidural is why she was able to have a “natural” birth of my sister.

And frankly, you’ve said such horribly false things so far that I’m tempted to say that anything you say must be the opposite, so you’d better have damned reliable sources for that claim.

Jacob Bunton

Cochrane review of the use of water for labour and birth concludes that there was a significant reduction in the use of epidural/spinal analgesia amongst women who used water immersion during labour (Cluett and burns 2009). Cluett and burns systematic review included eleven trials of over 3000 women.
Environment:
There is no doubt that birthing pools contribute to a helpful environmental ambience for birth.
Anecdotal evidence from busy labour wards suggests that when a woman is in the pool, there is less traffic in and out of the birth room. Is this because she is often naked in the water or is it because the lights are dimmed? Either way, other staff seem less inclined to enter the room. It feels like an intrusion into something private.
Therapeutic benefits:
Water facilitates movement movement and posture changes.
More likely to have an intact perineum (no tears) birthing in the pool.
Shorter labour (Zanetti-Dallenbach et al 2006, Thoni et al. 2007) and the reduction in the need for synthetic oxytocin augmentation (Cluet et al. 2004).

Causation and correlation are not the same thing. Most women who are willing to try hot water as pain relief are already opposed to epidurals, so it’s not surprising they get them less often than someone like me, who is like “fuck pain, it hurts, gimme the drugs”.

Oh, and a lot of hospitals are taking a second look at the pools because it’s really hard to sterilize them, and no one wants infections from blood and feces-laced pools. So there’s that.

demodocus

I don’t particularly like baths. Laboring in a tub or a damned ocean is probably not going to be relaxing. And what the hell is with your desire to give birth in the dark?

Heidi

Again, Jakey, they offered them for some time and women did not want them. The ones who did get them were not happy with them. Most women who opt for them don’t actually choose to walk around because there’s no guarantee your legs won’t be numb and they can make you groggy (hello, falls!). With an epidural one is fully alert.

Wow, it really bothers you women are no longer forced to experience horrible pain in childbirth.

Jacob Bunton

Ok, well glad we cleared that up.
So women had a choice of walking epidurals and then decided preferred not to have the mobile option. Great a choice was offered.
So what about water, do women have a choice of waterbirth or a pool on labour ward?

MaineJen

Could you get any more condescending?

demodocus

Probably.

Heidi

Do they have a choice to birth with dolphins? Do they have a choice to birth from a trapeze? I assume different hospitals may offer tubs – mine offered a shower. I live in a part of the US with high rates of obesity. Who is gonna be there to pull the mother out of a pool when shit hits the fan? It would likely take more than two people to pull someone out. How are they going to keep track of PPH when there’s no way to measure blood loss? How much more can we expect to pay if we go to a place that offers it?

Mattie

I think there was a photo on a thread recently with a hoist above the pool, that’s an option for getting women out safely. I also think that they do specific training on waterbirth which includes monitoring blood loss in the pool. Most of the births I’ve seen the woman gets out of the pool after delivery, and the placenta is delivered ‘on dry land’. It’s fine to not want a waterbirth, or want them to be better, but they’re a really important choice for some women and I’m glad more places are offering them.

Heidi

Well, I’m personally against more places offering actual waterbirths. I can’t see that they’ve been proven safe, especially in regards to the risk of hyponatremia and pathogens that the baby could more easily become exposed to. Now, I know it’d be safer to waterbirth in a hospital than at home with a CPM or unassisted even, but I guess I view that as enabling. To me, the best compromise seems to be some hospitals offering tubs for laboring only.

demodocus

Pretty sure I pooped during kid1’s birth. I don’t want to be in a tub I pooped in.

They threw away the poo chuck and wiped me with a damp cloth. It’s not like they were wiping me down with heavy duty antimicrobial wipes they might use on their equipment.

maidmarian555

Jesus Christ, just when you think you’ve heard it all some twit comes up with some ever more outlandish nonsense! We’re supposed to smear our newborns in our own poop now? What if you don’t poop during birth? Should you save some from your last bowel movement in a baggy just in case?! Is this the ‘new’ version of vaginal seeding? Gross!! And just nope. Nope. Nope. Nope.

Heidi

If you didn’t poo, it was probably because your sphincter closed tight because of blue lights and such. And you were too ashamed to poo, of course.

maidmarian555

Yeah I basically ticked off everything on our new friend Jacob’s list of things that are just *terrible* to do during birth. I also didn’t get to the pushing stage so missed out on poop…..

Hospital, check!
Induction, check!
VEs, check!
Lights on so that people could see wtf was going on and weren’t crashing about in the dark, check!
Didn’t crap myself, check!
Epidural, check!
EMCS, check!

Of course, the fact that me and my son are both alive and well clearly isn’t good enough and I should be sad I didn’t get to roll around in my own poop, growling, naked and birthing on all fours….. (I mean, if that’s what a woman *wants* to do then whatever but it’s not really my thing). Maybe I just don’t love my body enough and need to work on learning to embrace my poop?!

Mattie

But at what point in labour do you say ‘nope you have to get out now’ when she starts pushing? That can take a bit of time, at crowning? A lot of women don’t want to move much at that stage. What if a woman refuses to leave the pool, do you force her?

Heidi

I don’t have the answers which is why I am not really advocating for birthing or laboring pools. What do you do if a woman insists on birthing on the toilet? I suppose you tell her it’s AMA and carries risks and hope she’ll hop off the toilet. But if she doesn’t, you attempt to minimize risks, treat the baby appropriately and accept it.

Mattie

Yeh, we attended a BBA at home where the baby was born in the toilet, if in hospital I’d suggest a birth stool lol I saw a couple of water births, no problems, ofc there might be some issues but it’s about weighing risks and benefits and the mother making an informed decision, and I suppose if the hospital she wants to use doesn’t offer it then she can use a different hospital. Hopefully women won’t decide to birth at home without adequate support just for that though :/

I don’t think hospitals should offer waterbirth, because it’s not safe. I get that some women want it, but some women want to give birth with dolphins too (seriously, it’s happened!). Hospitals should not be in the business of offering options where there is no benefit but high likelihood of potentially lethal complications.

momofone

For some reason the dolphin thing makes me think of Dr. Seuss–would you labor in a box?
Would you labor with a fox? With an ox? Eating lox?

(I would not labor anywhere, Sam.
Not here or there, or with a bear.
Labor is not my selection–
I choose a repeat c-section!)

Heidi

Oh man, the only thing I really wanted my whole pregnancy was a smoked salmon and cream cheese bagel. Listeria is the only thing I really had a fear about so I chose to abstain from cold-smoked fish the whole pregnancy (although I was all about sashimi). I wasn’t really hungry when labor came around and definitely chose an epidural over getting to eat, but I think I’d have almost eaten lox. I told my husband the whole pregnancy, he’d have to bring me the sandwich the morning after labor but I settled for the hospital breakfast.

Charybdis

Some places, yes, but you cannot deliver in the water. Why do you ask?

demodocus

We could labor in a pool, if you weren’t high risk at both my hospitals. Waterbirth is stupid.

demodocus

No instruments in my 80th percentile headed kids’ deliveries and no episiotomy. 2 different hospitals and 2 different OBs.

Nick Sanders

“Risk of instrumental delivery”?

swbarnes2

Isn’t lumping episiotomy with “severe perineal trauma” also very dishonest? How likely is an episiotomy to do severe, lasting damage? I figured almost all of them heal up pretty fast.

Nick Sanders

No idea. But when I hear a medical procedure discussed as if it was an inherently bad thing, without explanation of why it is so bad, my bullshit detector starts going off.

Well, I didn’t bring the symphony but I did bring one of the singers. Okay, so he’s the father…

Azuran

Lets see, hours of atrocious pain still with possible instrumental delivery anyway, without any pain relief, or painless labour maybe more likely to be followed by instrumental delivery, still with an epidural.
I’d still take the epidural 100 times over natural labour.

demodocus

If your legs are dead weights, they put your epidural in wrong. You’re wobbly, which is dangerous in pregnancy, but you aren’t immobilized. And some of us prefer not to be on all fours.

Heidi

I couldn’t really move my legs when they actually got the epidural to work but I could have cared less! I took a few rounds of medication before I wasn’t in horrible pain but I wonder if it’s because I labored so quickly? I want to say I was 8 cm when they checked me because the epidural wasn’t working like expected. The OB really didn’t expect me to go from 4 to 8 so soon. Anyway I could still feel contractions (but in a non-painful way) and could easily push, and I was able to hobble to the bathroom later that night.

demodocus

were they actually dead weight, or more like swimming in cold molasses?

Heidi

I really couldn’t move them. To get the epidural to actually be effective against labor pains as I was already so far along, the epidural only got stronger for a while after labor. I suspect if the epidural had been administered before my water was broken, I could have gone with a lower dose that would have allowed my legs to move more. I went to the bathroom directly after she broke my water and the contractions hit me out of no where. I was on the call button demanding an epidural in less than 5 minutes. I think my case isn’t exactly the norm, though. I don’t blame the OB for recommending the epidural after getting my water broken because she had no way of knowing I’d go from not being into labor to being in serious labor within minutes.

moto_librarian

No, it’s not harder to push when you have a heavy epidural. I got a bolus when I was complete because the catheter had slipped out, and I couldn’t feel my toes, but I could feel the pressure and had no problems pushing at all. In fact, it was much easier.

Young CC Prof

Gas and air is uncommon in obstetrics in the USA. Epidural is preferred for birth over oral or IV pain medicines in most circumstances because the baby doesn’t get dosed, but opiates are used sometimes.

Mattie

Thanks 🙂 yeh gas and air super common here haha

Young CC Prof

They are supporting the goal of natural unmedicated birth by delaying requests for pain relief, because obviously all women want that.

Which is a really serious violation of medical ethics, when you see clearly what’s going on. If an anesthesiologist refuses to give one due to specific medical factors, that’s one thing. But if an oriented adult patient has clearly expressed a specific treatment goal (minimizing pain) and you decide to substitute your own goal of minimizing intervention, that’s completely unacceptable.

Deewhybaby

I don’t think it’s really a no, more a delay and distract until it’s too late. There may be a wait for an anaesthetist, probably only one on call to get through all the C sections and it adds to the workload of the midwife who are already stretched beyond capacity Plus a good dose of patronising, maternalistic, underestimation of a women’s pain. (Don’t make a fuss, dear)
I guess the pain relief of a mother isn’t a priority as long as they mostly come out alive at the other side. Wouldn’t wash in any other branch of medicine.

Azuran

Even in a public system, it doesn’t have to be this way.
I’m in Canada, as soon as I got in the labour ward, they asked what was my plan for pain relief (they had everything from epidural to bath to waterball to walking around)
I said I wanted an epidural as soon as possible. No one questioned me, the nurse actually seemed very understanding.
I was induced, and as soon as I had my first real contraction I asked the nurse what was the absolute soonest I could have the epidural.
I had to wait about 15 minutes, because the anesthesiologist was already doing another epidural. There was never anyone who questionned my need, who told me I should wait or should try for a natural labour. She did gave me some tips to come better with the pain but that was only for until the anesthesiologist was free.

Christina Maxwell

There’s one big, big problem with maternity funding/midwife caseload in the UK, offsite birthing units. They cost a lot, they have their own inherent dangers and the average number of births per midwife, per annum is 27 (not a typo). Where I live the average is 22. This is a hideous waste of scarce resources. Compare that with the caseload of the average hospital based midwife in any large city and you begin to see the difficulty!

Christina Maxwell

More like the top 10-20% but it doesn’t cover maternity care at all and the only private, hospital based maternity services in the UK are in London. If you live anywhere else you are shit out of luck even if you are privately insured up the wazoo. I managed to find an OB who did private birth in 1990, in Scotland. There are none up here now.

crazy grad mama

“Normal birth” makes even less sense as a brand than “natural.” “Normal” means “usual, typical, or expected.” It’s normal for laboring mothers in developed countries to request and receive epidurals and/or other pain relief. It’s normal for breech babies to be delivered by C-section. 50+ years ago, twilight sleep was normal – that doesn’t say anything about whether or not it was a good thing, just that it was a typical thing that happened. Home birth in the US today is not normal at all, it’s quite rare.

Anne

I am certain the move to using the word “normal” is calculated- “natural” has a hippy flavour to it which may be off-putting to those who do not macrame their underarm hair.

Jacob Bunton

No actually a study published in April 2017 – maybe you should check it out. I assume being an obstetrician you have access to Open Athens peer reviewed medical journals.

‘Labour and beyond: The roles of synthetic and endogenous oxytocin in transition to motherhood’

“Maternal endogenous oxytocin may help prepare the fetus for birth and may have a role in protecting the fetal brain during labour and birth. According to animal studies (Tyzio et al, 2006; Khazipov et al, 2008), maternal oxytocin crosses both the placental barrier and fetal blood–brain barrier during labour. It enters the fetal brain and prompts a transient switch in the action of the neurotransmitter gamma-aminobutyric acid (GABA) (Khazipov et al, 2008), changing GABA from having an excitatory to an inhibitory effect. GABA then inhibits fetal cortical neurons, reduces fetal brain activity for the duration of labour and delivery, and helps decrease the vulnerability of the fetal brain to hypoxic damage during birth. These changes start the day before the onset of physiological labour and have maximal effect during the second stage of labour. The effects of these GABA-induced changes include decreased central blood flow, decreased oxygen requirement and reduced vulnerability to hypoxic brain damage (Tyzio et al, 2006; Khazipov et al, 2008).

There is, however, disagreement about whether peripherally administered Syntocinon has the same effects, crosses the fetal blood–brain barrier and alters the neuronal actions of the fetal nervous system (Churchland and Winkielman, 2012). In theory, based on the pharmacological properties of Syntocinon, this drug is not able to cross the blood–brain barrier because of its large molecular size and hydrophilic nature. However, some animal studies have found low levels of Syntocinon in the fetal brain after parenteral administration, and that administration of high-dose synthetic oxytocin (Ceanga et al, 2010) or the oxytocin antagonist atosiban (Tyzio et al, 2006) block the oxytocin receptors, reducing the neuroprotective effects of endogenous oxytocin and increasing the fetus’ vulnerability to hypoxic brain damage.”

Amy Tuteur, MD

This is one midwife’s opinion. Note the use of “may” and “there is disagreement.” Syntocin is the exact same molecule as oxytocin.

Heidi_storage

According to one Kelly Brogan, MD, “pitocin” is not “oxytocin”–but nowhere in the article does she say how the two differ, save that pitocin “is the obstetrician’s whip. They snap this whip when your baby is not conforming to their non-evidenced-based schedules. When your due date is wrong, when you’re forced to birth in highly artificial circumstances, or when your physiology has been hijacked by an epidural.”

And here I thought you had to be smart to graduate from medical school.

LibrarianSarah

Are you being purposely disingenuous? Kelly Brogan’s Medical Degree is in psychiatry and she doesn’t even offer good advice in that field. (Pro-tip for Kelly don’t write a article telling people to go off their psychiatric medication. That shit is dangerous.) Do you also ask you podiatrist about for obstetrical advice?

You obviously don’t need to be smart to write a comment on the internet. Thanks for proving that.

Heidi_storage

I’m being sarcastic–about Dr. Brogan. No, you don’t need to be smart to comment on the internet; reading comprehension requires a bit more gray matter, however.

LibrarianSarah

Sarcasm tags (/s) exist on the internet for a reason. Your comment was not nearly hyperbolic enough for a reasonable person to assume sarcasm.

fiftyfifty1

I heard the sarcasm loud and clear. Does that mean I’m not a reasonable person?

The Bofa on the Sofa

According to one Kelly Brogan, MD, “pitocin” is not “oxytocin”-

According to Dr. Bofa on the Sofa, PhD in Organic Chemistry, pitocin and oxytocin are exactly the same molecule.

Similarly, according to Dr. Bofa on the Sofa, PhD, Kelly Brogan, MD doesn’t know shit about chemistry, and you shouldn’t pay any attention to any of her blathering. I TEACH people like Kelly Brogan about organic chemistry when they are students. However, the difference is that I teach them correct organic chemistry, as opposed to whatever nonsense she is making up.

Now that you have read it on the internet, you all need to believe it. You should, too, because I am right and she is wrong.

Karen in SC

Way back eight months ago, how did you miss that I meant clorite, ClO2(-), an oxyanion, when I posted about sodium chlorite. 🙂 I did mean the chlorite, though I don’t remember exactly why.

The Bofa on the Sofa

I missed it because inorganic nomenclature is really boring. Even more boring than organic nomenclature. At least with organic nomenclature, you have interesting parts, like why 4 carbon systems are called but- . And then there is the whole set of common names (like all the capricorn derived names (caproic, caprilic and caprolic acids) due to their prevalence in goat milk. I give a lecture that talks about common names. For example, the sodium lauryl sulfate in your shampoo is based on lauric acid, which comes from the laurel leaf, aka bay leaves. Apollo wore a laurel crown, and ingested laurel leaves were used to induce a trance for fortune tellers and as aphrodisiacs.

You don’t get good stories like that talking about chloride, chlorate, chlorite and hypochlorite.

BeatriceC

You’re bringing back nightmares now. General Chemistry was unreasonably difficult for me. I dropped it three times before I wound up with the amazing and wonderful Dr. Carl Hoff, who finally managed to break through the brick wall I had in my brain in regards to chemistry. I then went on to take organic and bio chem and wound up with a chemistry minor, but for whatever reason I just could not get any of it until his class.

demodocus

lol, I read that last one as “hippocrite” which seems fairly appropriate for certain parachuting trolls

Jacob Bunton

Not just midwives…Doctors seem to view synthetic oxytocin as a simple molecule and from a chemical perspective not different this is why you say it is the same.

Not as simple as that for 2 reasons
1) Natural pulsations occur with natural oxytocin and it needs to be that way.
Natural oxytocin comes in waves, pulsations
Drip of synthetic oxytocin (syn OT) is continuous.
Drip introduces a concentration above the physiological need.
2) We know it crosses the placenta. We know it can reach the placenta.
Blood brain barrier not yet active.
What does that mean?
When adult, brain protected
For example, synthetic oxytocin does not reach brain of the mother but does reach the brain of baby. Means the developing brain of a baby is under the effect of huge concentrations of oxytocin much higher than by natural means, because endogenous oxytocin is released in pulsations.
Many babies globally are exposed to huge concentrations of synthetic oxytocin at a critical time of birth.

Have good reasons to think it may have long term consequences. When think of next generation have to be worried by the common use of syn OT. By far syn OT (pitocin) is the most common medical intervention because its cheap (even poor countries use it, unlike epidurals which are expensive) and we know nothing about the long term effects on the baby and mother. At a global level synthetic oxytocin is replacing natural oxytocin. We should consider (if any) the potential risks or consequences of this.

MaineJen

It’s the same molecule. Interacts with the same receptors. Has the same effect on the body.

???

Amy Tuteur, MD

Do you have an data or just the wishful thinking of midwives? Pitocin saves tens of thousands of lives every year. Can you think of a single thing that midwives have discovered that saves lives on that scale? Me neither.

Jacob Bunton

Yes. But rather than resort to the old paradigm of doctors attacking midwives and vice versa, lets instead look to the fast emerging new developments in science. Science knows how to save lives. Science knows how to PROTECT the labouring woman from neocortical stimulation so she wouldn’t need synthetic oxytocin in the first place.

Karen in SC

How? When the baby needs to be born, due to rapidly declining placenta function, pre-eclampsia, or cholestasis of pregancy or dozens more reasons, there are 3 choices: 1. Induce and try for a vaginal delivery, 2. go directly to a c-section, do not pass GO, or 3. do nothing and wait for a natural birth that may well damage or kill one or both of the patients. Which do you pick? As a lawyer, you probably hope for #3 so you get more medmal cases, right? is that why you are here?

Jacob Bunton

Inductions with the use of synthetic oxytocin (after propess/prostin and/or artifiical rupture has failed to achieve active labour) for conditions such as pre-eclampsia, IUGR, obstetric cholestasis and other high risk conditions account for about 25-30% of women.

What about the rest?

The majority of women are well and healthy throughout their pregnancy and are deemed low risk at term. Recent studies (Birth place study (2011) based on 64 500 low risk women and Overgaard,C. et al (2011) Freestanding midwifery unit versus obstetric unit: a matched cohort study of low risk women British Medical Journal

Highlight the difficulties women encounter in birthing in a hospital environment. Despite arguments of ‘safety’, statistically risks associated with birth including augmentation of labour with synthetic oxytocin, regional anaesthesia, fetal distress, episiotomy, shoulder dystocia, instrumental delivery, post-partum haemorrhage, severe perineal trauma and caesarean section all either double or treble on a labour ward compared to the same low risk woman birthing either at home or within a midiwfe- led birth centre (Overgaard et al. 2011).

From a scientific perspective these findings could be explained by stimulants of the neocortex which are largely present on a labour ward. These stimulants include, bright lights (this reduces the release of the darkness hormone melatonin which works with the release of oxytocin), unfamiliar environment, being observed by a person or an object (including a CTG machine), use of rational language, noise, need for attention and sense of fear or danger.

It is the highly developed neocortex, which makes human birth so difficult compared with other mammals. And on that note with also reference to Amy’s book ‘Push back’ she lists animals which are either being observed in a zoo, on a farm or domesticated – similiar findings were found of mice and rats giving birth in the laboratory.

When our thinking brain is at rest and labour is undisturbed birth becomes easier and safer.

How?
Its simple really
But maybe too simple for the current dominant thinking
The solution
Keyword is ‘protect’
Scientists identify ‘inhibitory factors’
Birth process is a involuntary process but is typically being obscured by neocortical activity.
In medical books it says birth is difficult among humans because of shape of pelvis, size of the head etc.
But if the main factors were mechanical how do you explain anecdotes of a first time mother birthing in 10mins? eg. gave birth in the toilet I didn’t know I was pregnant headlines.

Difficulty is not mechanical. The main effect is probably neocortical activity.

Understand the solution nature found to make birth possible and simple is reduce neocortical activity. Birth it seems despite all these blogs by both midwives and doctors is not the business of intellect.

When woman undisturbed in birth she can behave in ways unacceptable in a ‘civilised’ world. Swear, bite, bizarre postures, mammalian. Even women’s smell becomes intensely acute. Neocortical activity is low. Like when we are drunk.

When we understand that a labouring woman is first to be protected from neocortical stimulation we are getting somewhere.
What are the stimulus of neocortex
1. First one is language – basic need is silence
2. Light – semi-darkness is needed to release hormone melatonin which works with oxytocin to cause contractions, birth of baby and placenta, and intitate breastfeeding
3. Feeling of being observed – basic need of labouring woman is not to feel observed
4. Needs to feel secure – basic need is to be protected from fear and anxiety – adrenalin is an antagonist to oxytocin.

We need to dare to think differently. To think like physiologists.

MaineJen

You lost me at “stimulants to the neocortex.”

And then there’s this: “When woman undisturbed in birth she can behave in ways unacceptable in a ‘civilised’ world. Swear, bite, bizarre postures, mammalian. Even women’s smell becomes intensely acute. Neocortical activity is low. Like when we are drunk.”

That may be the most offensive series of statements I’ve ever read on here. And that’s saying something.

Valerie

See my comment above- This guy is basically quoting Odent. It’s his opinion, and as far as I can tell, there isn’t research to back up any harms of “neocortical stimulation” to laboring women.

MaineJen

It also reeks of scientology’s “silent birth.” I wonder if we’ve got a live one here?

Jacob Bunton

haha no the labouring woman can make as much noise as she likes! She can do, say, be whatever she wants. But engaging her in a neocortical stimulating conversation such as this… ‘rational language’ numbers, questions etc. will definitely ‘wake her up’ so to speak, increase her neocortical stimulation, knock of the oxytocin and slow down her contractions. Leading to ‘failure to progress’ and hence warranting the need to intervene with synthetic oxytocin.

Sheven

I wish I could publish your every comment as widely as possible.

So that women considering “normal birth” see what a patronizing, logic-free community of creeps you normal birth people are.

You are the best advertisement for a midwife-free, woo-free hospital birth I’ve ever seen.

Kerlyssa

She can do and be whatever she wants, other than choosing to be a thinking human being interacting with those around them and free of unnecessary pain, suffering and danger.

Heidi_storage

I liked playing Scrabble, chatting with the nurses, and watching TV during labor, personally; the moaning and crying bit before I got the epidural was far less enjoyable. And even with epidurals, pitocin, and artificial ROM I felt pretty darned ecstatic when my children arrived safely and were placed in my arms. See, for me, the labor bit was just something to be gotten through so that I could get to the important part–meeting my child.

namaste863

God forbid a woman be “Intellectually stimulated.” Who knows what sorts of outlandish ideas she might get into her pretty little head?

momofone

She might even insist on not being in pain!

BeatriceC

Or even *gasp* a maternal request c-section!

MaineJen

“I want an epidural”

“No you don’t, dear. Just stop thinking, you’ll be fine.”

Roadstergal

You know, I was trying to think of where I had heard this line of thinking from, and it was from Dara O’Briain’s famous schtick about NCT classes, where the midwife alluded to exactly this. Avoid thinking and decision-making! It’ll interfere with The Wonderful Nacheral Birth!

This is the best illustration of the “keep em talking” principle I’ve ever seen. You see, I’ve found that a good way to deal with cranks is just keep conversing (calmly and rationally) until they say something outrageous and offensive enough to turn off 99% of normal people.

This guy, though? Labor problems are caused by women using their brains, and women will be fine if they just act like animals during labor. Apparently seriously!

Between this douchebag and “mother’s body doing the only thing it’s meant to do” douchebag, this post is just made of win.

Sue

Jacob Bunton is HILARIOUS!

Wait – are we being trolled by a clever twelve year old, posting from is bedroom?

Jacob Bunton

I’m sorry you have never had the privilege to be at an undisturbed, physiological birth. There is a moment when she cuts herself off from the world. She is uninhibited and her actions, unexpected noises and positions reflect this. She seems to be in an ecstatic state at the time of and shortly after birth. And she, the mother will tell you so..so will her smile. I never seen anything so beautiful as birth. And that’s saying something.

Uh yeah, the cessation of pain is indeed an ecstatic event- ask anyone who has been in severe pain and then it stops. The body does produce endorphins to help you deal with the pain, so no pain + lots of endorphins is a very ecstatic feeling. That doesn’t mean that birth doesn’t hurt like a son-of-a-bitch, because for most people, it does.

And if you think that writhing, moaning, and grunts are beautiful … that’s just sick. Those are pain sounds. Pain does cause a lowering of inhibitions against making a scene, true, but that doesn’t make it a good thing.

momofone

I was in an ecstatic state too-my smile would absolutely confirm this-when my son was born. That c-section is one of the most beautiful things I’ve ever experienced. I didn’t even have to bite anyone.

Your clearly strongly held opinions about something I assume you have not personally experienced are interesting to me. It seems similar to my belief that medication-free vasectomy is beautiful and life-affirming. Opinions are easy when you literally have no skin in the game.

demodocus

Methinks he mistook “ecstatic” for “exhausted”. The two words are very similar sounding.
/sarcasm

Here’s my list of more beautiful moments:
1) When the nephrologist told the mom in the NICU next to me that her baby had a single aberrant test result and that her son’s kidneys were sound and normal. No dialysis or transplant needed.

2) When the one of my students labor was safely stopped. She was 22 weeks pregnant at the time. Her daughter was born at 38 weeks after her mom had been on hospitalized bed rest for 89 days.

3) When another NICU family walked out with their fourth child healthy and thriving after losing two previous children to extreme prematurity.

4) When I realized that my husband was trying to convince our son’s neonatologist to use my husband as a blood donor for our premature son – in spite of the fact my husband is a very hard person to get an IV in.

5) The first time I went to pick my son up out of the bassinette and he locked eyes with me and grinned.

6) When a student who worked 3 jobs to support his younger siblings became the first person in his family to graduate from high school – and all of his siblings were there to watch.

7) When a neonatologist told me that problems my son’s lungs were having were because he needed a very unusual ventilator setting combination – but that he didn’t have extremely severe lung damage like we feared.

8) When two adult women refugees who came from a remote tribe that didn’t have a written language learned to read English well enough to read a child’s book to their children.

If the only place you see ecstatic people is women who have just given birth, you really need to get out to more places.

Sarah

wot no breastfeeding?

Mark

Hugh

I am a man, so never experienced child birth.

But how is pain enthralling.

I just got a calf cramp

Pain went straight to a ten. Lasted maybe a minute, a really long minute. Causing involuntary cursing and moaning.

Nothing exhilarating about that.

Sue

Pitocin and Syntocinon are oxytocin.

We need to think like pharmacologists and endocrinologists.

Azuran

The 15 minutes I had to wait for my epidural where the most painful ever, And I had an open fracture as a child.
You want the privilege to act like a rabid dog while giving birth? go for it. I am choosing the privilege of science, comfort and safety.

Daleth

I never seen anything so beautiful as birth. And that’s saying something.

How many births have you been at? Just asking because you seem not to understand that different women labor differently and can have completely different experiences, even when they both have an unmedicated, uncomplicated birth.

In other words, how birth went for your wife is just how birth went for your wife. Not “how birth would go for everyone or most women if only we did XYZ.”

Azuran

I sure as hell don’t think there was anything really beautiful about the birth of my daughter by itself. SHE is absolutely gorgeous, her first cry, seeing her and holding her for the first time where all absolutely magical and overwhelming and I don’t even have words for it.
But the birth itself? pfff, horrible.
There was nothing ‘beautiful’ about leaking huge amount of amniotic fluids constantly for hours in my home, my car and the hospital. Nothing beautiful about being in so much pain I couldn’t breathe, the exhaustion of pushing after being awake for over 36 hours, soiling myself in front of others…
I’m actually glad I’ll never have to do it again.

moto_librarian

Yeah, catching up on this thread and seeing all of the bullshit from Captain Mansplainer is a good reminder to check the threads on my Mirena.

SporkParade

I had an undisturbed physiological birth. It really fucking sucked.

Jacob Bunton

Were you in a hospital, midwife led unit or home? Were people withholding pain relief, shouting at you to push under a bright light, were you on a bed or in water? Did you know the people caring for you?

SporkParade

Ah, I see, this is the part where you try to convince me that you know better than silly female me what “undisturbed” means. I had no desire to be in water, or at home, or to have candles and mood lighting at 10 AM, and the hospital midwives were absolutely lovely. It sucked because it hurt like hell.

Linden

My grandmother was pregnant 11 times, and had home births, no bright lights, no nothing.
Only 4 of her children made it to adulthood.
You should really REALLY STFU.

Who?

You know, I had what you would call an undisturbed physiological birth. It was fine. A moment in time. Then I had another. It was fine too. Not awesome, not awe inspiring, fine.

The outcome was two kids, which was the awesome, awe inspiring bit of the whole process.

Back then epidurals weren’t as well developed as they are now, and were a lot more fussing around to achieve. Would I have an epidural now? You bet. I’d probably have a planned section if I could swing it.

And that’s what I say when people ask-we know more, we do better. Go to where the machines go ping and the pain relief is on tap. Life does not need to be a suffering competition.

Charybdis

What difference does any of that make?

moto_librarian

A hospital, cared for by a CNM that I knew. Her mother was my labor nurse, which was actually kind of cool because they worked very well together. I pushed in every position imaginable until I was simply too exhausted to stand up and move around anymore. Lights were dim. I sipped Sprite between pushing contractions. Didn’t even have a fucking heplock. None of this made a bit of difference.

demodocus

I suspect this bloke might be the disturbed one.

MaineJen

Yeah…I remember labor, thanks. “Ecstatic” is not the word I’d use. *Jesus christ with the mansplaining over here*

moto_librarian

Shut the hell up. I had an undisturbed physiological birth. I did not find being “uninhibited” to be ecstatic – it was misery. It took about 20 minutes for it to register that the screaming that I was hearing was not a woman in another room, but myself. Having a manual examination of my uterus when I began hemorrhaging after birth is a searing memory; it’s quite something to find yourself contemplating your own death at the moment that you have given birth to your first child. I never told anyone that there was anything beautiful about that birth, other than the fact that it gave me my adored son. I don’t ever want to hear anyone, but especially not a man, tell me about how amazing physiologic birth is. In fact, why don’t you try sticking three of your fingers up to the knuckle into your own urethra without pain medication and get back to us. That’s roughly equivalent to what having my midwife’s hands in up to her elbows was like. Let us know if that’s “ecstatic,” you assbag.

Valerie

“how do you explain anecdotes of a first time mother birthing in 10mins? eg. gave birth in the toilet I didn’t know I was pregnant headlines.”

Simple: biological variability. Some people have fast labors. Some mistake their labor for the need to defecate. Some don’t feel much pain during labor, but most do.

Please provide evidence that women who are “protected from neocortical stimulation” according to your scheme have better outcomes. You aren’t “thinking like a physiologist;” you are just repeating what you have heard from natural birth advocates.

KQ Not Signed In

You….really don’t understand how oxytocin and pitocin work. Or how science works.

“The different hormones released during the birth process …. originate in archaic brain structures such as the hypothalamus and the pituitary gland. In other words, the most active component of the body of a woman in labor is the primitive part of the brain. It is also well accepted that during parturition or any episode of sexual life the possible inhibitions originate in the neocortex. These facts are essential to interpret the particular state of consciousness that characterizes women in labor. During parturition many women tend to become less rational, behaving in a way which would be unacceptable in the daily social life, daring to scream or to swear. This particular state of consciousness is associated with a reduction of neocortical activity. Hence, it becomes easy to explain that a woman in labor needs first to be protected against any sort of useless neocortical stimulation.” (“New reasons and new ways to study birth physiology” 2001 Int J Gynecol Obstet)

As far as I can tell, there is no data to support his opinion that laboring women need protection from “neocortical stimulation” (moving, talking, vision, listening, thinking, fetal monitors… basically anything non-vegetative), that these things create a need for pitocin or are harmful in any way. He just “reasons” it out, and then it has been parroted endlessly by natural birth advocates.

Gæst

Daring to scream and swear! I’m DYING over here. If that’s evidence of labor hormones then I’ve been in labor for about 20 years now. LOLOLOLOL

AnnaPDE

It’s well known women only do such unladylike things in total isolation. Never was a woman in labour observed to shout at people around her incoherently, especially not when there was light, sound or any other “neocortical stimulus”.

MaineJen

Dear Jacob would faint dead away if he visited my house…my kids learn all their best words from me 🙂 As I did from my mother before me.

Amazed

I have not even given birth yet. The Intruder and his family were here for a day and I have lost count just how often the words, “err, she isn’t around, so she can’t hear me, right?” left my mouth. I’m afraid that in many of the cases she was, in fact, around. When walking around the house, she prefers crawling and she was on a constant mission to find out where each one of us was before returning to guard the teddy rabbit. I know for sure I have contributed to her vocabulary.

Jacob Bunton

Would I? 😉

MaineJen

You seem pretty shocked that a woman would yell or swear outside the extremis of labor, so yeah, maybe?

Young CC Prof

Is he trying to claim that postpartum hemorrhage is caused by thinking? The Victorians telegraphed, they want their writing back.

Azuran

If anything, stress causes vasoconstriction, the uterus isn’t an essential organ, so being stressed would theoretically reduce PPH. I propose we hide very scary clowns under the bed of labouring women. if they bleed they jump out and yell ‘BOOH!’

Young CC Prof

In some degree of seriousness, I don’t think that would work. You see, normal arteries have strong muscular walls that allow them to open wide or shrink down, which is how the body diverts blood to one area or another. When fetal cells infiltrate the uterine lining, however, they actually strip away those walls, to make a better placenta. Stress doesn’t cause vasoconstriction of the spiral arteries in the uterus, because it biologically can’t. (Except in disorders of under-infiltration.)

This is why the uterus contracts tightly postpartum. The arteries that are bleeding can’t spasm, so the great muscles of the uterus itself clamp down to stop the blood flow like a natural pressure bandage. This is also why a very long labor increases the risk of PPH: The uterus is just too darned tired to contract properly.

Heidi_storage

Nah, the Victorians were more realistic about PPH than that.

Jacob Bunton

The Victorians….
Semmelweis discovered that the incidence of puerperal fever (also known as “childbed fever”) could be drastically cut by the use of hand disinfection in obstetrical clinics. Puerperal fever was common in mid-19th-century hospitals and often fatal. Semmelweis proposed the practice of washing hands with chlorinated lime solutions in 1847 while working in Vienna General Hospital’s First Obstetrical Clinic, where doctors’ wards had three times the mortality of midwives’ wards. He published a book of his findings in Etiology, Concept and Prophylaxis of Childbed Fever.

Despite various publications of results where hand washing reduced mortality to below 1%, Semmelweis’s observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community. Semmelweis could offer no acceptable scientific explanation for his findings, and some doctors were offended at the suggestion that they should wash their hands. Semmelweis’s practice earned widespread acceptance only years after his death, when Louis Pasteur confirmed the germ theory and Joseph Lister, acting on the French microbiologist’s research, practiced and operated, using hygienic methods, with great success. In 1865, Semmelweis was committed to an asylum, where he died at age 47 of pyaemia, after being beaten by the guards, only 14 days after he was committed.

“Semmelweis’ observations and deductions in 1847 were original and astute. But most of the claims made about him in the 20th century – that he was the first to discover that puerperal fever was contagious (see, for example, Gordon6), that he abol- ished puerperal fever (or that if he did not, it was because of the stupidity of his contemporaries), and that his treatise is one of the greatest works in 19th- century medicine – are sheer nonsense…”

Heidi_storage

Yeah, the Victorians knew a lot less than obgyns nowadays know, which is why it’s pretty sad that NCB philosophy is a step back from Victorian medicine. They at least recognized that birth is dangerous and unpleasant without intervention, which is more than you seem to do.

So…we should start the Milwaukee protocol (minus the antivirals) for rabies every time a woman goes into labor to quash neocortical stimulation.

That seems like quite a strong intervention to prevent getting a IV of pitocin 😛

Well, once the NCBers find out that we’re shooting women up with ketamine and midazolam as a standard delivery protocol, perhaps they will stop whining about epidurals….. 😀

Valerie

I hear twilight sleep also protects mothers from neocortical stimulation. Why did we stop doing that again?

Amy Tuteur, MD

And this nonsense justifies the preventable deaths of babies at the hands of UK midwives?

Sheven

Again, I think Jacob should be widely published. This is to normal birth what Thetans, Xenu, and Fair Game is to Scientology. Usually they hook you with “probably there should be fewer c-sections” and then slowly dial it up. This guy went full crazy with “rational language numbers” and “neocortical stimulation” right at the beginning. This is where the normal birth movement leads! It leads to a guy saying that women should be isolated in a room without medical equipment, not thinking or communicating so they can feel free to bite people and scream as they deliver their babies.

Charybdis

Sooo….how about uterine atony and PPH? Or weak, unorganized contractions?

demodocus

I didn’t even *get* contractions until they started the pitocin. My water had broken, but who needs the rest of that stuff?

Azuran

Same for me, my water broke, didn’t have any contraction so I had to get induced. And still by the time I had my c-section I had a fever. So clearly, waiting around until my labour started on it’s own would have been a terrible idea.

Jacob Bunton

Would it?

Heidi_storage

Yes, it would. Letting a woman sit around for a long time after her water breaks leads to very bad outcomes–things like sepsis and death.

demodocus

Of course it would. Fever in a laboring woman who doesn’t have a cold might be a clue that something is wrong.

Well, if infection, sepsis, and/or death in both mother and baby aren’t considered a bad thing, then it wouldn’t have been a bad idea to wait. Most of us here in the “reality based community” consider those problematic, though, so to avoid said things it would indeed have been a very bad idea to wait.

Azuran

Seriously? You think that just waiting around, without any progress in my labour, and ending up with an active infection because my water broke hours ago while still not in labour would have been better?

MaineJen

She developed a fever…so yeah, terrible idea.

Jacob Bunton

Azuran had induction. An induction requires insertion of propess or prostin or automatically starting synthetic oxytocin (pitcoin). Women generally receive more VE (vaginal examinations) who are being induced than those in spontaneous labour, using the pool etc. Why? Because their labours tend to be longer. 98% of women receiving synthetic oxytocin will ask for an epidural. Naturally so, their endorphins are knocked off, pain is excruciating they can’t use a pool or any other effective pain relief. These women are exposed to more VEs, the more VEs the more risk of infection. This is called chorioamnionitis. Waiting 24hrs and well, it is likely the woman would go into spontaneous labour, be contracting well, use the pool, have probably max 2-3 VEs (Ve every 4hours) as opposed to a 11 VEs! before her baby is born. No fever, better outcome.

Heidi

Azuran’s water broke before labor. Usually the water breaks after labor begins. That means likely she had already developed an infection.

Jacob Bunton

Not true

MaineJen

Exactly what about that statement is “not true?”

Jacob Bunton

15% of women break their waters before labour starting, this not due to infection. As said many of these women, over half ,labour begins spontaneously and no induction is needed.

MaineJen

No, the *fever* signaled a probable infection. Do you listen?

Jacob Bunton

Yes in some cases this true but not all. Plus the woman would present with a raised temperature and other signs of pyrexia in which case antibiotics would be administered and labour induced or depending on the level of infection an immediate c-section could also be warranted. The important point is not all women have an infection when they SROM (spontaneous rupture of membranes) and that is why the NICE guideline recommends waiting 24 hours if the woman is well.

Azuran

Look at how he moved the goalpost: ‘NICE guideline recommends waiting 24 hours’
That’s really not what you have been arguing all this time, no one here has even said that all women with broken membranes should be instantly induced.
And yes, my fever was significant enough that did have 48 hours of IV antibiotics.

Jacob Bunton

No? Whose moving the goal post?
I am glad to hear that in our global community no medical professionals (obstetricians or midwives) are offering all women immediate induction when they SROM and are waiting 24 hours before inducing labour if there are no signs of pyrexia.

Azuran

You might want to check out your previous comments. You’ve been here, arguing that neocortical whatever is the reason we can’t have babies naturally, that the rate of c-section is too high, that lights are too strong, that we should be giving births like mammals. Whenever we show how stupid your claim is, you jump on the next one.

Jacob Bunton

No. Amy deleted my comments explaining about ‘protecting’ a woman in spontaneous labour, and how labour could be disturbed/interrupted and therefore become longer, more painful , less safe hence warranting the need for medical intervention.

Amy Tuteur, MD

Nothing was deleted.

Jacob Bunton

My mistake.
Are your followers able to see a comment when it says..’Hold on, this is waiting to be approved by The Skeptical OB.’

Jacob Bunton

My mistake.
Are your followers able to see a comment when it says..’Hold on, this is waiting to be approved by The Skeptical OB.’

Good. Just checking as Amy has tendency to delete (police) comments which don’t support her views. Notice as a collective group you all are kind of saying the same thing. Thank you though for engaging with me. To be honest I didn’t think I’d get this far.

demodocus

You don’t read many of the more controversial posts, do you? If she did that, we’d never have posts with over a thousand comments.

Jacob Bunton

Enlighten me. Can you post an example?

Nothing more boring than everyone agreeing and intermittedly slagging off a sole voice.

I NEVER delete comments that don’t support my views. Why would I when they often demonstrate the ignorance of the commentors?

Heidi

No, *DR.* Amy doesn’t have that tendency.

Azuran

You really haven’t been around much. Dr. Amy almost NEVER bans anyone.

moto_librarian

No, she does not delete comments. Sometimes I wish that she did.

Heidi

Doubtful.

Azuran

‘No’? ‘No’ What? You absolutely have been making all those stupid claims.

Azuran

How patronizing. I sure as hell don’t need your ‘protection’ of my natural labour. The only protection I need is FROM childbirth.
Childbirth is dangerous, and without the protection of modern medicine, it could have killed me in many way.
My grandmother would have died of massive blood loss from placenta previa giving birth to my mom, possibly taking my mom with her.
I probably would have died in-utero because no matter how long they waited, my mom basically just NEVER goes into labour.
My daughter would have died in-utero as well, since her head was too big, and the infection eventually would have killed me as well.
My daughter also needs protection from my own blood, because our blood type are not compatible.

Women and babies have died in absolutely huge numbers for all the human history. Until a few decade ago, every single woman out there knew she had a very real chance of dying every single time she fell pregnant. Everyone knew someone who had died in childbirth. All those women were probably terrified and extremely stressed, and yet, they still gave birth. So your belief that ‘disturbing’ labour is affecting us negatively is ridiculous. Labour by itself is extremely disturbing, it doesn’t need any help for that.

Martha G

*applause*

Azuran

we4 waited to see if it would start on it’s own. It didn’t.

EmbraceYourInnerCrone

I gave birth in 1994, one thing the OB and the nurse who ran the Lamaze class stressed: If your water breaks or your THINK your water has broken, call your doctor and Go To the hospital, because once the amniotic sac is ruptured even if its just a small leak high on the wall of the amniotic sac, it allows bacteria to get to the fetus and placenta (they also checked for amniotic fluid at every appointment as I recall, something about the pH of amniotic fluid being much higher than normal vaginal pH)

Fun fact, my water didn’t break before labor started but was broken by the labor nurse quite late in the labor.

NO ONE here is saying that a woman’s water breaking is CAUSED by infection, they are saying not delivering soon after the water breaks sets one up for developing an infection and sets one’s baby up for possible life threatening complications.

Jacob Bunton

Good I’m glad we are all on the same page that water breaking is not caused by infection. Correct women are told to call labour ward if they think their waters have broken, this is not an emergency, it is to confirm that their waters have actually broken. Many women get a discharge and think their waters have broken but they have not, a doctor or midwife will check and confirm. Correct a prolonged labour does increase the risk of infection, this is probably due to more VEs being done. A PROM (prolonged rupture of membranes) not so much, for example if a woman was 28weeks what would we do? Induce her or wait?
The recommendation is to wait.
If a woman has preterm prelabour rupture of membranes, induction of labour should not be carried out before 34 weeks unless there are additional obstetric indications (for example, infection or fetal compromise)
If a woman has preterm prelabour rupture of membranes after 34 weeks, the maternity team should discuss the following factors with her before a decision is made about whether to induce labour:

Tell that to the CPMs who are letting people have homebirth and labour 5 days at home after their water broke.
You are just trying to change the subject and making you look good. You where here arguing about how we should act like mammals, how light is bad for us and how pitocin is the causes of all the diseases on earth, not having an science based discussion on when you should start pitocin

Jacob Bunton

I will tell the CPMs

Heidi

I actually am saying that. A pre-existing infection can cause water to break in the absence of labor. I am not saying it’s the only cause.

MaineJen

Yeah, I’m familiar with chorio. It’s why I was induced after SROM and no contractions/no dilation after 8 hours. A midwife would have sat there on her hands while my baby developed an infection that could have killed him.

You have NO IDEA what you’re talking about.

Amy Tuteur, MD

Jacob comes from the long line of privileged men mansplainin’ childbirth to us womenfolk:

If you truly want to know, I had exactly 2 ‘vaginal exams’. One when I they confirmed my water broke (and it wasn’t even a real exam, she barely put half the speculum in and so much water came out she didn’t go any further) and another one 10 hours later, 6 hours after my induction began.

Jacob Bunton

Yes that would be correct. VEs are generally done not sooner that 4hrly from established/active labour meaning 4cm with 3 contractions ever 10mins, moderate to strong on palpation.

Azuran

Therefore, unlike what you insinuated, my infection WASNT caused by VE. It just happened because my water was broken, and it happened after only 14 hours.

Azuran

1h after that 2nd exam, I started to have a fever, Not long enough for it to have been the vaginal exam.

Charybdis

What about women who have babies that are OP positioned? Back labor? How do you feel about antibiotics when the mother is GBS positive, because that can have disasterous end results even without vaginal exams?
Smooth muscle contractions HURT. Ever have diarrhea cramps? Pass a kidney stone? That is what contractions are: smooth muscle contractions and those are a special kind of hell to experience.
And walking around with ruptured membranes with no contractions is just begging for an infection.

Jacob Bunton

OP – What are you asking about OP position? I know what it is but in what context.
GBS positive yes antibiotics recommended. This can be administered at home, midwife led suite and OU (obstetric unit – labour ward) i.e in all birth settings.
I agree with you regarding contractions.
Let me tell you a story..I was with a labouring woman on labour ward, bright lights, people coming in and out of the room some asking her what she wanted for breakfast, others wanted to know if she’d like to donate her placenta (once birthed) to research which she had to read 4 pages and sign a consent, others looking for various things in cupboards, doors opening and closing, now ward round, doctors and medical students come in, time for VE, lots of noise on the ward, emergency bells going off. A lot of anxiety and stress. The woman was having her first baby, a low risk post-dates induction, so far she had only had propess and was now 6cm contracting 3 every 10mins, strong on palpation…she was screaming for an epidural.
I asked her if she had heard of the midwife-led suite (MLS)which, at this hospital is on labour ward just the rooms are designed differently. I told her she may feel more relaxed there and she can use the pool which significantly reduces the pain. I reassured her that absolutely she would be given an epidural if she still wanted it. She said she’d give it a try.
So with a gentle 3 minute walk, pausing waiting for contraction to pass we moved to the Woodland room (MLS). Once in the room, with its soft lighting, looking more akin to a spa, she got into the pool. Her face lit up she sighed a sigh of relief and said ‘This is wonderful!!’ Not once did she ask for an epidural and birthed her baby in the pool 5 hours later. She told me how much she loved the pool and how grateful she was to be offered the choice to use it, she said the care and atmosphere ‘was amazing’ and ‘got [her] thru it’.

Jacob Bunton

NICE (2017) “If a woman has preterm pre-labour rupture of membranes, induction of labour should not be carried out before 34 weeks unless there are additional obstetric indications (for example, infection)
So what is the recommendation if waters break and you are term? Induction? No
The recommendation is to wait 24 hours. Why because 68% will go into labour? In 48hrs 96% will spontaneously go into labour?
What about infection?
For those women choosing to wait longer than 24hrs we advise that they take their temperature every 4 hours and be mindful of fetal movements.

Young CC Prof

Yeah, that’s not how it’s done in the USA.

Immediate induction and induction after a delay have about the same outcomes, except that the risk of chorio increases the longer induction is delayed. Spontaneous start of labor is all well and good, but not if the mother becomes seriously ill before delivery.

Azuran

It’s really up to the woman actually. It’s the job of medical professional to give the option and help the woman make her choice. I was offered doing an induction right away, waiting until morning, or waiting with close surveillance until something happened.
The baby has to be born, I seriously see no reason not to get it out sooner. And I’m glad I decide to have an induction in the morning, as the result of trying to wait 24h would have been horrible.

Jacob Bunton

Absolutely I agree with you Azuran it is the woman’s choice.
And yes it is the job of the medical profession to discuss the options and risks and benefits of each, so woman can make an informed choice.
My concern is not all women are being given a ‘real choice’.

Roadstergal

“My concern is not all women are being given a ‘real choice’.”

That is a legitimate concern. Many woman who want maternal-request C-sections are scared out of the option by bad information or outright denied and forced into vaginal birth. Many women are not given real information about the risks to the baby and herself from vaginal birth. Many women who want pain relief are talked out of epidurals or are given the UK midwife ‘delay and distract’ treatment and suffer agonizing pain, some (like my friend) to the extent that they can’t remember the birth of their child.

Many woman are browbeaten into breastfeeding by BFHI policies, that forbid formula and allow LCs and nurses to grab and manipulate women’s breasts when they’re exhausted and/or medicated.

Forcing women to use their breasts and vaginas for the benefit of others is assault, even if it’s done with the blessings of Jacob Bunton.

“Natural pulsations occur with natural oxytocin and it needs to be that way”

Except: when endogenous oxytocin is insufficient, or has insufficient action, and mother and baby are at risk of dying in childbirth. Thankfully, these days, it doesn’t need to be that way.

Jacob Bunton

What makes endogenous oxytocin insufficient?
What could hinder its release?
Why do women birth better (statistically) in a warm, relaxed, dark, quiet environment?

Charybdis

Oh, stop mansplainin’ stuff to the poor little women. I had a magnificent “birth experience” with my son.
Brightly lit, warm (thanks, warmed blankets!) and fairly quiet as I was not “vocalizing”, screaming or making mammalian noises. Epidural firmly in place, all the drugs prior to epidural insertion, morphine afterwards. Best C-Section EVER! In fact, if I was ever to have another, I would opt for maternal request CS, pre-labor, because that experience was AWESOME! No VBAC or TOLAC for me. Attended by OB’s, no midwives for me.
Oh, and to totally make your head explode, absolutely no skin-to skin immediately after delivery, because ewwww! Clean the baby up and hand it to my husband. And exclusive formula feeding for the win!
Because smug NCB apologists like yourself need to be defied into apoplexy at every opportunity. Standing there beside yourself, red-faced and damn near hysterical, trying to convince women that their pain, discomfort, and bodily autonomy do not matter one whit.
You sir, are a bounder, a cad and a jackass of brobdingnagian proportions.

Jacob Bunton

I was not “vocalizing”, screaming or making mammalian noises. Epidural firmly in place. Brightly lit, fairly quiet. [Contractions slowed down, I needed synthetic oxytocin drip]. Baby became distressed. Best C-section ever. In fact [I wouldn’t go through all that again] elective c-section next time. No VBAC for me. Cared for by OBs, no midwives for me. no skin to skin. [breastfeeding wasn’t successful] exclusive formula for the win.

Charybdis

Nope, not even close. Contractions started 5 hours prior to scheduled CS, were 20 minutes apart when the anesthesiologist was called. No pitocin in sight, nor was my son distressed. Hated breastfeeding, so I don’t think that qualifies as “failing” at breastfeeding.

I don’t feel slighted, cheated, traumatized, overly interventioned or birth raped . Nor do I feel like I missed out on anything. CS is awesome and I value my pelvic floor health and the fact that I have been reliably toilet trained since toddlerhood and don’t have incontinence issues due to vaginal birth.

What does it matter? You’ve been on a L&D ward and you don’t know the difference between an elective c-section and a MRCS? Colour me impressed – not.

Jacob Bunton

Just asking as there seems to be some benefits (according to some latest research) to an In labour Non-emergency c-section as opposed to an Elective c-section without any contractions. For example a woman with a planned elective c-section but goes into labour on that day, though very early labour there seems to be a benefit to having contractions for the baby. Apparently the stress of the contractions, and release of cortisol activates the hippocampus part of the brain for learning, memory and development in the fetus and also the breastmilk is apparently different too.

Amazed

No. Elective c-section doesn’t mean a c-section without any medical reason. Elective c-section simply means that the c-section was planned in advance. A c-section for a breech baby planned and carried out before labour can start is an elective c-section, yet it is medically needed.

I find it hard to believe that you can work in a L&D ward and not know the difference between elective and mother request. It’s very misleading to say “elective” as a substitute to, “Stupid lil woman doesn’t know what’s best for her and her baby. She wants to go overseas for a lovely holiday/doesn’t want to lose her figure by carrying to term/doesn’t want to be inconvenienced with pregnancy anymore”.

Heidi

There is a person who comments here quite frequently who had an intervention free, unmedicated birth and what happened is she has a serious rectocele that will require costly surgery. Have you heard of obstetric fistulas? You know where these mostly occur? In the developing world where women don’t have access to technology and interventions. They have natural childbirth without “blue lights” with no pain relief yet this happens. And even more heartbreaking is many of these women lose their baby in the process. Why are you insisting we adopt those standards?

moto_librarian

Yes, that would be me. Funny how those dim lights and totally spontaneous labor and delivery were unable to prevent a cervical laceration, pph, and second degree tear. I now have rectocele and heavy nerve damage. So until Mr. Bunton needs to splint every time he needs to move his bowels, he can fuck right off.

An estimated 2 million women and girls in Africa live with obstetric fistula

It is estimated that another 100,000 develop the condition every year

More than 500,000 women die each year during pregnancy or childbirth, mostly in developing nations

80% of these deaths are completely avoidable

In 2005, 8 million women around the world experienced life-threatening complications during pregnancy and childbirth

So while I’ve been typing this, we can assume 3 dozen women have been seriously injured or disabled during childbirth.

Heidi_storage

Why are you asking? Her reasons are her business.

demodocus

Perhaps she wanted to ensure future continence? I haven’t been reliably toilet trained since I gave birth vaginally 3 years ago

Daleth

I’ll say it again, CS, formula and nurseries ROCK.

Add my voice to the choir! I had to fight my doctors for an elective CS even though I was carrying mono-di twins (in themselves an indication for CS). They were waving the vaginal birth pom-poms while I was waving a half-inch stack of studies printed out from PubMed, explaining that I had evaluated the risks of both types of delivery and preferred the risks of CS.

And it’s a good thing I did, since it turned out — and FYI, Jacob, this isn’t something that can be detected prenatally — both twins had extremely short umbilical cords (23cm and 25cm), so if I had tried to give birth vaginally, Baby A’s delivery would have ripped off the placenta, leaving Baby B with no oxygen. The only possible outcomes then would’ve been (a) his death or permanent brain damage, or (b) if we were lucky, a crash CS under general anesthesia to save him.

Formula was awesome because it made up for the fact that I never produced even close to enough milk for two. And nurseries were awesome because a mother whose preeclampsia added 70 lbs of water weight (for about a 60% increase in my total weight), who is recovering from a CS, and who had a hemorrhage that almost killed her, is in no shape to have 24/7 responsibility for the care of newborn twins.

momofone

Amen. I never had labor at all, went straight to c-section. Spinal worked beautifully, was not restrained (as I had been told by numerous people would happen if I had a section), OB/nurse anesthetist/pediatrician/nurses could not have been more wonderful or more professional, and baby was of course the most beautiful baby ever born–and he was alive! The assisting OB helped me hold him while I was sewn up, and my husband went with him to the nursery. I breastfed for 21 months. If I did it again, I wouldn’t change a thing, except I’d formula feed exclusively. Zero interest in VBAC, but might try skin to skin once baby was clean and warm and fully checked out. (I’m not sure that counts as skin to skin, maybe it’s just snuggling.)

Melaniexxxx

They don’t.

Jacob Bunton

Really? Share – how do you know that?

Box of Salt

“how do you know that?”

Back at you, buddy – link your statistics here or there is nothing to discuss.

Can you dim the lights on a delivery suite on labour ward?
The lights on delivery suite are so bright! Like show time Las Vegas, far brighter than what we would choose to have at home. Melatonin the darkness hormone works well in labour. There are melatonin receptors in the uterus which work with the hormone oxytocin. When all the lights are on this interrupts this delicate hormone interplay and release.
Plus you don’t need all the lights on for an internal (vaginal examination) its an internal, just enough light will do just fine.

MaineJen

WTF? Yes you can. When were you last on a labor ward?

Jacob Bunton

It was a rhetorical question

Azuran

That absolutely wasn’t rhetorical.

Jacob Bunton

I’ve been on labour ward long enough to know you can dim the lights. Dimmer switch is there for a good reason, maybe a reason better than we originally thought, maybe we should start using it.

Azuran

Then why where you saying that lighting in labour ward is a problem if you know they can and are dimmed.

MaineJen

It’s just so much easier to mansplain when you ask questions to which you already know the answers.

Aine

I’m a few days late to this but have always been utterly baffled by the dim lights thing and find Jacob’s posts hilarious until I realise he is serious.

Jacob, can I tell you my experience of the lights being dimmed on my consultant-led delivery suite? It was right after the epidural took and the main lights were turned off so my husband and I both caught up on sleep until my dilation was complete. Bliss. Then the “let’s have this baby” moment, lights back on so everyone could see what they were doing – including me. I had spent a long time growing that baby, damn right I wanted to be able to get a good look at him.

But hey, it was probably the lights going back on that caused the multiple nuchal cord that led to his safe, rapid vacuum delivery, right? And the paed consultant who was on hand to check him over immediately after birth (they put him on my chest first and were going to leave him there for a minute until I shrieked that if there was any doubt about this health following the instrumental delivery, I didn’t want a second’s delay in the paed starting his work).

There is no light brighter than the sun. Women have been having babies, safely and unsafely, at every hour of the day and night since the dawn of time. If light is the last thing standing between us and the guaranteed health of every mother and every baby, I’d be pretty happy with that. But we have a long way to go yet.

MaineJen

LOL Okay dude

momofone

So when WERE you last on a labor ward?

Jacob Bunton

last night

momofone

In what capacity?

Nick Sanders

I think he means he was born yesterday. Just like he seems to think you ladies were.

Heidi_storage

Please tell me you’re not a health care provider.

momofone

I think he’s a “health care provider.”

Heidi_storage

I am horrified that he seems to be hanging around unsuspecting women in labor. The whole business is tough enough without Mr. Primal Scream explaining that epidurals and pitocin are bad, and that all the woman really needs to do is crawl around a dark room moaning and yelling “Fuck.”

Heidi

The staff has probably already caught on and he so much as steps foot in the hospital, security escorts him right out.

Roadstergal

And covered in poop. Don’t forget that part.

Poogles

And biting people.

demodocus

maybe he’s one of those foolish chiros who think newborns need “adjustment”

Heidi

I wonder if he’s trying to be a homebirth doula?

Heidi_storage

Maybe, but that little story he told where he got the stressed-out laboring woman to move to another birth suite seems to hint that he may actually be connected with a hospital in some professional manner–I would imagine they don’t allow random people to accost laboring women. Either way, the thought makes my hairs stand on end.

Heidi

Oh, I think I missed that post. Maybe he’s a janitor? Or *was* a janitor or some other non-medical role at the hospital.

Heidi_storage

One can only hope.

Heidi

Or perhaps they are his fevered imaginings. Maybe he watches Youtube natural birth videos and often gets carried away.

You are so full of shit. Women have given birth in broad daylight, outside, on a regular basis. It’s better to have shelter because it’s safer (less wild animals, possible to keep clean, etc.), but it has nothing to do with light levels. Birth is a biological process- it’s messy and prone to error, but it’s also got a wide variety of conditions in which it works fine. It’s not some delicate clockwork where any one thing going wrong means everything fails altogether.

Jacob Bunton

Outside? Shelter? Birthing alone in the wild? who said anything about that?
– Broad spectrum lighting and its interference with melatonin.
‘Melatonin and Oxytocin’ – Google it.

You said bright lights were bad. Outside in the sun is bright light. Ergo, women can’t give birth successfully outdoors in the sun, at least according to your “logic”. And who said anything about alone?

Azuran

My labour room was like 3 times the size of my actual room. It was very comfy, and yes I absolutely could dim the light.
Following your logic, it’s bad for women to labour during the day.

Heidi

My room was like that too. They had a bright portable lamp they only used when the delivery team was called when I was literally two pushes from delivering. Somehow despite the bright light I managed to give birth.

Jacob Bunton

No its certainly not bad for women to labour during the day.
Its the type of light which is problematic, blue light that is emitted from digital devices, laptop, mobile phones, computers, as well as fluorescent and LED lights so often used on labour wards.

Hey, maybe they should just use UV lights and women can get a tan while laboring! I wouldn’t be shocked if Jakey is a UV rays cause skin cancer denier.

Jacob Bunton

You know how they recommend not looking at your phone, or laptop before bed or trying to sleep with a fluroescent light bulb in your face- well (excuse me young prof for insulting your intelligence) but its because it makes sleep more difficult. Sleep relies on the hormone melatonin and oxytocin. So does birth. Both melatonin and oxytocin work together that is why there are melatonin receptors in the uterus.

Heidi

I managed to fall asleep in Algebra during my freshman year of high school and once or twice in college. How is that possible with all the fluorescent lights?!

demodocus

it’s called labor, not siesta

Azuran

The sun is also a source of blue light.
Meaning that dimming the light during the day would be bad, and strong hospital lighting would be encouraged during the daytime if a window isn’t available.
(Or you could just quick your nonsense and realize that no one is having trouble giving birth because of stupid light-bulb)

maidmarian555

Sorry, now you’re just lying. ALL the delivery suites in the hospital I gave birth in had lights which could be dimmed. In the onsite midwife-led centre upstairs they also had birthing pools, fairy lights, whale noises etc etc. In my bog-standard suite I had an en-suite bathroom with an enormous bath, birthing balls, you name it, they had it. And this is just an NHS hospital. You are totally misrepresenting what is now normally available to labouring women in hospital.

demodocus

Having been in Vegas a number of times, I have to say those casinos are actually fairly dark

Jacob Bunton

Not when you are approaching Las Vegas from the desert!

demodocus

I have. Many times. My grandparents lived in North Las Vegas, and besides the Luxor, it isn’t really that much brighter than Manhattan at night. In the daytime those lights would be far outstripped by that glowing orb in the sky.

Jacob Bunton

Either way don’t you think if a woman has melatonin receptors in her uterus, and melatonin works well with oxytocin which causes her contractions, to birth her baby and placenta and to breastfeed, don’t you think it is a good idea we do all we can not to disturb and instead protect/ promote the release of these hormones?

demodocus

No. I think you’re a blithering idiot. I know several totally blind people. Now Bert and Molly are pretty relaxed, but Rob, Larry, and Jean are -really- high strung.

Azuran

I spent all the night in pretty calm and very dimly lit areas, then I was left pretty undisturbed during all my labour. It really didn’t do anything to help.

momofone

I think we might want to ask said woman what SHE wants to happen with the aforementioned body parts rather than being presumptuous.

Nick Sanders

That’s a hell of a non sequitur.

Roadstergal

Yes, casinos are typically dimly lit. They like to keep people from thinking too much and noticing what’s going on. Interesting that this is also Jacob’s stated goal for laboring women.

demodocus

Yeah, he also acts like when you drop *any* modern city, without its suburbs, in the middle of the desert, they won’t seem just as bright. Las Vegas only has 2 incorporated neighbors, Henderson and North Las Vegas. Hasn’t the dude -been- to Times Square? Even Cleveland’s theater district is pretty darn sparkly

MaineJen

I suppose he would also remove all clocks and windows from delivery suites.

Nick Sanders

Uhm, who the hell is “we”?

momofone

I wondered the same thing. The “we” I am part of has no interest in home medical procedures of any kind. No home appendectomies, and no c-sections in the dark. Bright and easy to see all the monitors, thanks. (And the first person to approach me with essential oils may need medical care him- or herself.)

Mattie

You absolutely can, most of the delivery suite rooms can be made dark and quiet, and can have music played from personal music players. It was always a bit of a pain in really dark rooms cause you’d be trying to write notes in very little light, but if women wanted it dark it could be made dark.

Poogles

“The lights on delivery suite are so bright! Like show time Las Vegas, far brighter than what we would choose to have at home.”

Speak for yourself – I like bright lights, at home and everywhere else. In fact, it’s a constant struggle between my husband and I, since he prefers dimly lit rooms.

swbarnes2

Then the answer is for moms to wear sunglasses, so that the medical professionals can have enough light to read and write.

You do know that Caroline Lowell died in a poorly lit birth tub right? Just the kind of birth you think all the women here shoudl experience, right?

Also, you understand, I don’t think anyone believes that you have ever been in a delivery room.

moto_librarian

The lights in my hospital room were dimmed for delivery per my request.

MaineJen

As were mine. Didn’t make it hurt one bit less.

demodocus

I didn’t request it one way or the other and they were dimmed anyway.

AnnaPDE

In most hospitals around here, you can. I guess there are places where people are glad to have medical care at all and don’t worry about dimmable lights, but I’m pretty sure you’re not talking about those.
This question shows pretty clearly that you’re talking out of your ass.

Box of Salt

Maybe you should re-read your link. I don’t see “warm, relaxed, quiet environment” mentioned in the summary.

I’ll admit that I don’t have the time right now to review (and I do mean RE-view) the actual study right now, six years later.

demodocus

Personally, I prefer bright; I was already warm enough and the room was quiet enough for me. My apartment was often noisier, depending on if they finished redoing the parking lot or if the neighbors were having a party. And the professionals try really hard to project a relaxed environment, because panic is a stupid thing to encourage.
Not a fucking thing involving birth, breastfeeding, or exercise has ever allowed me to get a nice dose of oxytocin.

sdsures

Define “birth better”.

ChickyDee

Ummm, you do realise this isn’t an actual study right? This is one author’s summary of some cherry-picked other research. (Based on my reading of the abstract and the selections you’ve quoted – I’m not going to bother logging into my workplace system or library to get around the paywall). There’s not even any evidence that she did a proper systematic literature review (which could be considered study).

Push Back – you say that there is no difference between synthetic oxytocin (Pitocin) or endogenous oxytocin (hormone naturally released) – well apparently there is.

And another thing prominent obstetricians feel that it is the overuse of synthetic oxytocin (to speed up contractions) which is contributing to the dramatic increase in “claims for brain damage and cerebral palsy”.

“During spontaneous labour, endogenous oxytocin is released from the pituitary gland and initiates uterine contractions. In some women, it is necessary to induce or augment labour contractions. Induction or augmentation of labour using synthetic oxytocin (Syntocinon) is one of the most common interventions to facilitate the progress of labour and birth. Both Syntocinon and endogenous oxytocin affect the body through oxytocin receptors. Although the use of Syntocinon is regarded as a relatively safe intervention during labour, it works in a different way from endogenous oxytocin and has different effects on the mother and child. Syntocinon may negatively affect birth outcomes for mother and baby, interfere with the success of lactation and breastfeeding, impair the mother-child attachment and may affect the child’s development. We review the effect of endogenous oxytocin and Syntocinon on the health and wellbeing of women during labour and after birth, discuss the benefits of endogenous oxytocin and highlight some adverse effects of Syntocinon.”
M. KhajeheiApril 07 2017 BMJ

swbarnes2

This abstract says nothign of substance, and if I can’t get into the British Journal of Midwifery from my work, I bet lots of other people can’t get to it either.

Stop quoting law centers and quote some papers that we can actually read. And since this post is about how the British midwife community is awful, you will be taken far more seriously if you find sources other than British midwives.

Amy Tuteur, MD

Are you really citing a law firm on an issue of chemistry? Your ignorance is truly breathtaking! Thanks for parachuting in to make a fool of yourself.

namaste863

I read the article, and what struck me is that she assumes every woman without exception either wants a “normal” birth or doesn’t know she wants one and that once the baby is born she will realize that it’s what she wanted all along. I’m a student psychotherapist/Social Worker. You know the first thing they teach us? Newsflash: NO ONE GROUP OF PEOPLE WANT ANY ONE FUCKING THING!!!!! Some want minimal or no intervention or pain relief. Fine. As long as it can be done safely, they can knock themselves out. Others (the majority, I think) couldn’t give less of a shit about “naturalness” and want whatever it takes to get through it as safely and painlessly as possible. Being told “You silly dear, you don’t really want an epidural, you’ll thank me later” is patronizing, infantilizing, and quite unethical. Let me put it another way; the dentist I had as a teenager, I was seeing a dentist that had a thing against Novocain. He drilled several cavities on several occasions without any at all. Each time I requested it he kept telling me “oh, you will be numb for hours, and you might bite through your lip, and it’s really not a deep cavity so you really don’t need it.” Well, I suppose I didn’t, because i got through it, but it certainly sucked the big one a LOT more than it needed to and I most definitely didn’t thank him later. In fact, I was miserable and monumentally pissed off at being treated like that. Now that I’m an adult I have, needless to say, found a new dentist and just refuse to participate in any dental procedure without being properly numbed up. I think the parallels between that and forcing women into one particular model of childbirth are pretty obvious.

AnnaPDE

This. I wanted a CS. No normal, natural, or whatever else they’ll call vaginal birth for me, thank you very much.
There’s no ethical, moral or any other obligation for normal birth. There’s an obligation to respect women’s choices and protect their and their babies’ lives though.

Lisatgray

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Cory

I have midwives in the US, and about to give birth to my second with them. While I can appreciate the overall message you’re trying to convey, how many babies were give thalidomide or moms given cytotec before anyone thought to rethink so much intervention? There is a responsibility on the part of the parent and provider, but suggesting that midwives are morally bankrupt is unfair. How many unnecessary c-sections have been done because an OB has insisted that a mother’s body isn’t doing the only thing it’s meant to be doing? Deciding that she isn’t progressing enough when you’ve stripped her membranes or broken her water before it’s time to, or insisting that she not be able to eat before this marathon of childbirth (how is she supposed to have enough energy to go through a process that can take two days with no food in her system?).

That said, in cases where OBs are necessary, thank goodness they’re available and you can have a complicated birth in a place where they can receive what they need, but for when OBs aren’t necessary, Midwives provide care that’s just as good. At least, in my own personal experience. My midwives have always shown concern for my health and the health of my children, so I’m upset that this article suggests broadly that midwives don’t do that.

The Bofa on the Sofa

How many unnecessary c-sections have been done

You tell us, Cory. How many c-sections HAVE been done? In fact, tell me a single example of an “unnecessary c-section”? (HINT: you can’t, because it is logically impossible to know that a c-section was unnecessary; in order to know that, you would have to know that a vaginal birth would NOT have resulted in a complication, and that cannot be known; the only way to know a vaginal birth would not have a complication is to do the vaginal birth and have it come out ok)

because an OB has insisted that a mother’s body isn’t doing the only thing it’s meant to be doing?

WHAT IN THE HELL????!!!! “the only thing it’s meant to be doing”??????

You have to be joking. No one can be this fricking insulting.

Jacob Bunton

You can tell an unnecessary c-section
By looking at the cord gasses
That’s why they are taken.
7.25 – 7.4 – Normal pH baby is well
7.20 – 7.24 – Pre-acidosis
Less than 7.2 – C-section warranted
p.s leave the poor lass alone no one can be this ‘fricking insulting’ especially to a pregnant woman – that goes for you too Amy.

Continuous electronic fetal monitoring (CEFM) (CTG machines) are not always that accurate or reliable. Sometimes they pick up maternal pulse rather than the baby’s heartbeat or there is a loss of contact – so it can look like the baby is in distress when its not. FBS is a way to find out.

Nick Sanders

What are the risks of the FBS procedure, and how long does it take from initiation to results? And how accurate and reliable are said results?

Charybdis

Here you go, Nick…..

Fetal Blood Sampling

What is fetal blood sampling?
Fetal blood sampling is a procedure to take a small amount of blood from an unborn baby (fetus) during pregnancy. Fetal blood sampling is usually done by a perinatologist with special training. This is a doctor who specializes in the care of babies in high-risk pregnancies.

Why might I need fetal blood sampling?
Fetal blood sampling is a very complex procedure. It must be done by a doctor with special training. It’s done when other tests or procedures are not possible or do not work. It can be done for pregnancies that are 18 weeks or later.

Fetal blood sampling is done as part of diagnosing, treating, and checking problems in the baby at certain times during pregnancy. A fetal blood sample may be taken to:

Diagnose genetic or chromosome abnormalities
Check for and treat severe anemia in the baby
Check for and treat other blood problems such as Rh disease
Check oxygen levels in the baby
Check for infection in the baby
Give certain medicines to the baby
The benefits of fetal blood sampling include:

It often gives specific information about the health of the baby.
A baby with severe blood diseases can be treated before birth.
What are the risks of fetal blood sampling?
The risks of fetal blood sampling include:

Bleeding from the fetal blood sampling site
Changes in the baby’s heart rate
Infection
Leaking of amniotic fluid
Death of the baby

And you think that IF they pick up anomalies on the fetal monitoring, they aren’t going to check it out and just rush a c-section???
OF COURSE they are going to make sure that they aren’t listening to the mother’s heart, and if there is a loss of contact they are just going to put it back.

And again, how the hell do you propose that they do cord gas analysis in a baby that is still in the womb?

momofone

“The only thing it’s meant to be doing?” Exactly what does that mean?

The Bofa on the Sofa

It means that Cory has a very sad view of women.

Sheven

Except this is the same thing. The problem isn’t intervention vs non-intervention, it’s the ability of one group of people to see that a certain procedure is causing a problem and re-evaluate it.

And, forgive me, but you make some very bad arguments. “In my own personal experience” doesn’t mean much. In someone’s own personal experience, thalidomide was a wonder drug. As for “what a mother’s body is meant to be doing,”–for a lot of mothers throughout history, that was die. Nature doesn’t care if you live or not. If your pelvis is too narrow, if your baby doesn’t turn right and at the right moment, if you’re prone to infection, if your blood pressure is too high or your ability to resist hemorrhage is too low, as far as nature is concerned your body is meant to die.

Mark

In my own experience

Sure many births are ‘easy peasy’

But if something goes wrong, it can be deadly.

Erin Oakley

Watch out for that Mike Stevens guy on ScienceBasedMedicine. He’s a white supremacist and Holocaust denier:

Even if that were true, and looking over Mike’s profile gives me no reason to believe it is, what the fuck would that have to do with this discussion, which does not involve Mike in any way?

demodocus

Are you sure Stevens wasn’t being sarcastic? They can be over there.

Erin Oakley

Maybe. We can ask him what he thinks about aliens. I have heard him say some weird stuff.

Heidi

Oh yeah, you seem totes legit. Your name was Erin Oakley a couple of days ago and now you’re Kris Preston. Whatcha doin? I assume stealing people’s names ​and pictures and posting shit and then screenshotting it. Otherwise ​post the actual link because I know Mike doesn’t have his profile private. You didn’t like the truths he spoke about vaccines? We aren’t conspiracy theorists over here so you’ll have to try harder to be convincing and I’d suggest you don’t. I’m sure you could get yourself in some legal trouble.

Kris Preston

Nope. He’s told me personally that “Mike Stevens” was a pseudonym. I can make-up whatever ridiculous crap I want to about a pseudonym.

Is Heidi your real name?

Nick Sanders

That’s not how pseudonyms work, dumbass.

Kris Preston

What? Are you retarded?

Do I have to copypaste the definition of a pseudonym for you?

Nick Sanders

It’s not his real name. He’s still using it to represent himself. Therefore, you’re still engaging in defamation and libel.

Kris Preston

For attacking a character? LOL. Yeah right.

Can Walt Disney™ sue me for something I say about Mickey Mouse?

Nick Sanders

It’s a false name, not a false person.

Kris Preston

Maybe he should use his real name then.

I’ll leave him alone. He’s actually nowhere near as bad as some of the others.

Nick Sanders

People making fake posts claiming he’s a holocaust denier are probably exactly *why* he’s not using his real name. Not everyone is comfortable having a sick fuck trying to harass them and ruin their life.

R. Gere

It’s a pseudonym, calm down. This is not nearly as bad as what some of the others have said.

Is Nick Sanders your real name?

demodocus

Mike is almost never here anyway, so why are you defaming him here?

Heidi

Do you believe an undercover cop has to tell you s/he’s a cop if you ask? I’m ​not a lawyer and I don’t engage in such petty antics like you so I don’t really worry myself about the legality of what you’re doing, but maybe you should.

You are fortunate that that has been your experience with midwives, but it has no bearing on the experiences of those who were not so fortunate.

Amy Tuteur, MD

But apparently they DON’T provide care just as good since babies are dying preventable deaths and the NSH is wasting more than a billion dollars on paying claims for dead and brain injured babies. Which part of that are you having trouble understanding?

One of principles of medical ethics is autonomy. Many women do NOT want what UK midwives want, but midwives think they know better. Sadly, many have become every bit as paternalistic as the doctors they denigrate. It is no more ethical for midwives to promote “normal birth” in order to increase their professional autonomy than it would be for doctors to promote C-sections in order to make more money.

Amy Tuteur, MD

By the way, you are just regurgitating natural childbirth propaganda. Thalidomide was never approved for us in the US and when obstetricians found out that Cytotec increased the risk of uterine rupture in VBACs, they stopped using it. They didn’t whine that it wasn’t their fault and that it wasn’t fair to blame them.

Mark

Many years ago, I always disliked the word paternalistic used negatively. We don’t think of maternalistic as being being negative.

As a man I always hated the idea, well doctors are paternalistic towards female patients because: they don’t give birth, they are sexist. They are reductionist*

It’s nice (or not) to see that women can be just as condescending as men, maybe even more so, since they might get some leeway from some women because they can’t use the paternalistic/sexist card.

As we see here, ones genitalia does not make a good doctor.

* as an aside, I love it when some women online attack other as being male sexist and paternalistic, and the person turns out to be female. Happens all the time.

I must say, the mansplaining + utter lack of engagement with actual arguments + ad hominem attacks is sooo close to a Troll Bingo … c’mon, just one more square!

EDIT: Wait, MRA nonsense. Yes! BINGO!

Mark

Huh ?

Saying that men and women are equal is wrong?

Saying that cultural influences effects men and women both negatively is wrong?

A label is right?

You figured this all out by reading a few sentences of mine?

I suppose if I was a nurse or a elementary school teacher or a stay at home dad, and people thought that was strange due to gender stereotypes tat would be fine?

Note, all questions, leading questions, but questions.

Azuran

‘The only thing it’s meant to be doing’? How about you go fuck yourself, women are SO MUCH MORE than their Uterus.
Is producing sperm and fertilizing women the only thing men are good for?
And no men has EVER, in the entire history of human kind been sterile or had erectile dysfunction. Viagra isn’t a thing that exist.

BeatriceC

MrC would be glad to hear that last part. *eyeroll* He’s over 60, and at that age, well, sometimes things just don’t work the same way they used to.

Heidi

Eh, I managed to throw up my breakfast the day I was induced (just pitocin and breaking water) and not eat the rest of the day until after I gave birth at 6:41 PM. The vaginal kind of birth that required pushing even. They kept track of my glucose and I’m pretty sure if I said I feel too weak, they would have checked my sugar and administered glucose if necessary. I don’t really think an OB would have let me labor two days without more intervention like a C-section. I think a C-section would be pretty prudent in that situation.

Lilly de Lure

I’m sorry you are upset that Dr Amy suggests that UK midwives may have other priorities that get in the way of their ability to correctly look after their patients. However, having (unlike you) actually experienced UK midwifery and maternity provision first hand I can assure you that this is very definitely the case, at least with some midwives. Sure most midwives show (and I have no doubt, even feel) deep concern for their patient’s wellbeing, however their feelings and how much they show them are worthless if, when push comes to shove they allow that wellbeing to be compromised in order to promote their ideology. Alas this happens sufficiently often in the UK for practically every nhs trust which has looked into neonatal deaths over recent years to have found a small mound of little corpses of babies whose deaths were preventable quietly swept under the rug by UK midwives.

Sarah

And those deaths are simply the worst examples of such practice. They must and should, of course, take centre stage in this discussion. Absofuckinglutely. It’s also true, however, that there are hidden examples of midwives having allowed patient wellbeing to be compromised to promote ideology too. The way I felt after my epidural denial experience won’t be visible in statistics, except for those involving complaints to PALS I suppose. Neither me nor the child I so painfully delivered are dead. But it’s still an example of the phenomenon you discuss. The impact of it is felt on a sliding scale.

So that’s not to argue with your 100% correct centering of neonatal deaths in the discussion. It’s just there’s more too, that’s hidden, so there may well be trusts where there aren’t any deaths attributable to this attitude but that still feature it as a problem.

By no means all UK midwives are like that, and some abhor it, but enough are like that.

Lilly de Lure

Absolutely – mothers being unnecessarily injured or traumatised by insistence on doing things naturally, to say nothing of children having avoidable birth injuries are a vital feature in this discussion (as are ignored near misses – my son and I are both fine so don’t show up on any figures either and we basically got a shrug and a “you’re both OK in the end so what are you complaining about?” – no lessons even acknowledged, never mind learnt so the next woman might not be so lucky, this is the antithesis of the way near-misses are supposed to be handled by every other specialty in the NHS).

This is not least (given the government we’ve got at the moment) because it makes a nonsense of the argument that natural birth is cheaper for a cash-strapped NHS than interventions – if all goes well a totally unmedicated birth is but when things go wrong the cost of fixing/ living with the results can and does hugely dwarf these savings (special care units for damaged infants are hugely expensive, particularly if the baby is there for weeks or months, lifetime support for an individual with bad CP ain’t exactly chump change either).

swbarnes2

You would be far more convincing if you hadn’t blown your credibility by claiming that people give babies thalidomide as an intervention.

When OBs aren’t necessary, taxi drivers do just about as well at delivering babies. The midwives first job should be to realize when OBs are necessary, but in many places, like Morecambe Bay, they don’t do that.

KQ Not Signed In

“a mother’s body isn’t doing the only thing it’s meant to be doing?”

Hi. Just a reminder that women aren’t walking incubators.

My body isn’t ONLY meant to build and birth babies. In fact, MY body isn’t even meant to do THAT, thanks to a genetic defect I carry.

Every woman is more than her uterus. Every woman is more than reproductive organs and mammary glands.

That line of thought gets us to The Handmaid’s Tale – while an excellent book and a phenomenal series, it is a horrific view of women and motherhood (which is THE POINT of The Handmaid’s Tale).

demodocus

The thing with c-sections is that we cannot know which ones were unnecessary. For instance, Stage IV ovarian cancer typically kills in less than a year, especially when it’s come out of remission. My sister has lived 4 years since her 2nd bout started and 10 since the original. She got lucky but that doesn’t mean it was foolhardy of her to write a will 10 years ago.

MI Dawn

In the US, no babies were exposed to thalidomide IF they had an US doc. Women got it from other sources but it never passed FDA approval in the US.

Yes, I’m sure some c-sections end up being unnecessary. Some appendectomies end up being unnecessary, too. Should we worry about those? Or do we go on the best available information, do the surgery, and end up with a healthy patient (with baby for c-section) who goes home. Not a dead one because “we can wait, it’s all normal”.

The Bofa on the Sofa

Yes, I’m sure some c-sections end up being unnecessary.

Oh, this is obviously true. For example, we know that, in fact, a large fraction of breech births can be delivered successfully vaginally. It might even be 75% or more. That means that 75% of the c-sections we do for breech presentation are unnecessary.

However, as demodocus notes below, the question is WHICH ones are unnecessary? And the answer is, we don’t know. You can not look at any single c-section and say that it was unnecessary.

Kerlyssa

when playing russian roulette, a bullet proof vest is unnecessary 5/6 times

When my son was born, there was a chance that I as a first-time mom with an unfavorable cervix, pre-e with HELLP syndrome and a 26 week breech preemie could have had labor induced for a “normal” vaginal birth (without an epidural or any form of global pain control *shudders*) that ended with my son and I alive and well.

The chance of death of both of us was much higher than the chance of a good outcome, though, on that route and some morbidity for both of us was pretty much a given.

I love modern medicine. I really, really do.

Jacob Bunton

‘You can not look at any single c-section and say that it was unnecessary.’
That’s not entirely true couch surfer.
You can by looking at the cord gasses (from umbilical cord attached to the placenta after birth, sometimes taken during birth called FBS fetal blood sampling).
That’s why they are taken.
7.25 – 7.4 – Normal pH baby is well
7.20 – 7.24 – Pre-acidosis
Less than 7.2 – C-section warranted

Heidi

Okay, Captain Hindsight.

Jacob Bunton

Yeah you hear doctors say that a lot ‘hindsight is a wonderful thing’

Young CC Prof

After birth, you can see that. And even when the pH is normal, you have no way of knowing that the baby would have been born before acidosis set in.

Please tell me how an obstetrician can determine all this at the time the decision must be made.

Azuran

And how can you do that blood gas analysis while the baby is still in the womb, you idiot?

Jacob Bunton

FBS is not a routine procedure. It is only clinically indicated when the CTG trace is non-reassuring. The procedure will require the woman to have a vaginal examination using a device similar to a
speculum.
A sample of blood will be taken from the baby’s head by making a small scratch on the
baby’s scalp. This will heal quickly after birth, but there is a small risk of infection.
NICE intrapartum care (2017) RCOG.

Heidi

Then while we wait, the baby is further damaged or dies. Nice.

momofone

Many people would choose to deliver rather than taking their chances with their baby’s life. Count me among them.

Azuran

Except that signs of foetal distress are relatively common. So FSB would need to become a routine procedure that everyone can do with a moment’s notice. A very significant number of babies would end up needing it.

MaineJen

LOL. How do you plan to discipline the doctors/moms who partake of unwarranted c sections, then?

momofone

Unnecessary just means that when it’s over everyone has the good fortune of being ok. If that disturbs you, you’re absolutely free to refuse whatever potentially unnecessary procedure is being offered. You also get to live with the consequences of having done so. I am medically as risk-averse person as you will ever meet, so I will gratefully take my chances on side of conservatism.

Mark

“How many unnecessary c-sections have been done because an OB has insisted that a mother’s body isn’t doing the only thing it’s meant to be doing? ”

Any one read this?
Looked at the evidence?
Asking questions?
Is the capacity to give birth deteriorating?
If a physiological function is being underused, what happens?
If most women (low risk women in spontaneous labour i.e labour started on its own not induced) are giving birth with interventions such as a drip of synthetic oxytocin –
Are there any reasons to worry?
Does it have any long term effects on mother or baby?
Given our oxytocin system plays a role in our immunity and well-being, fertility, sexual performance, breastfeed, mental well-being, our ability to connect with others, to bond, our emotional wellbeing- and we are seeing dramatic rises in rates of depression, fertility rates dropping, ability (it seems) to give birth without intervention declining, rises in cancer, auto immune diseases, autism, behavourial problems in children ADD – any link?

Young CC Prof

Rises in cancer? Guess you haven’t checked the latest figures, age-adjusted cancer rates have been dropping for 20 years.

FormerPhysicist

Generally, a rise in the number or percentage of people dying of cancer is a very good thing. It means they aren’t dying earlier of other things. Even my 8-year-old understands this, because we talk about news and medical studies and the ignorant things health teachers say.

demodocus

Especially -old- people dying of cancer. Not a great way to go, but for heavens’ sake, my sister had a head injury when she was 5 or 6 that caused her to be life-flighted. It’s possible she wouldn’t have lived to finish kindergarden even if the damned cancer doesn’t let her reach 40. (I won’t lay odds, though. She’s been surviving it for a decade. Who gets ovarian at 28?)

FormerPhysicist

I wish her (and you) good health!
And, yes, your caveat is appropriate.

Jacob Bunton

Interesting – share the study please

Azuran

So, are you advocating that we should let babies and women die in childbirth if they can’t achieve it naturally? Because that’s what it means when you complain that intervention are reducing our ability to give birth.
Should we ban hormonal treatment for infertility? Ban IVF? After all, infertility could be somewhat genetic.
Since autism is mostly genetic, should we prevent people on the spectrum from having children?

Do you realize the utter ugliness of what you are saying?

Jacob Bunton

You are missing the point.

Azuran

And what IS the point? You are complaining that we might be damaging our ability to give birth by doing intervention. The only way to reduce this would be to not let those who need intervention reproduce.
Pitocin isn’t given to women for funzies, they give it when it is needed.
Going overdue causes an increased rate of stillbirth. Waiting too long after your water broke causes infection to both the woman and the baby. Unproductive labour due to weak uterine contraction can eventually result in a stillbirth as well. Uterine atony can cause death from PPH.
And there is absolutely no evidence whatsoever that using pitocin causes auto-immune disease, cancer or whatever. Your body does not make the difference. it’s the exact same freaking molecule.

momofone

I’d be very interested in a straight answer from you to Azuran’s question: “So, are you advocating that we should let babies and women die in childbirth if they can’t achieve it naturally?”

No, it really isn’t. Pitocin, syntocin, and oxytocin are the same molecule and they do the same thing in the body. They aren’t given in a drip unless necessary, and they are given to try to prevent unnecessary C-sections. C-sections are performed for fetal distress- while many of those babies would be born without damage, many would not, and we don’t have a good way to figure that out before birth. Cord gas tests are incredibly dangerous while in utero, so we don’t do them- we use other, external measures of fetal distress like heartrate instead.

Giving birth isn’t reliant on any one position or light level. Epidurals and other pain relief measures are wonderful things if a woman wants them. Women don’t enjoy being in pain, usually. We are perfectly capable of giving birth without screaming, biting(!!), and cursing. We’re also capable of doing all of that not in labor. Furthermore, watching someone writhe, scream, moan, and grunt isn’t beautiful.

I think that covers most of it.

Martha G

Completely right, Feminerd – I simply can’t understand why anyone would make a case for it. It’s so utterly incomprehensible to me that you would want to see someone in unnecessary pain (or indeed endure it) that I can’t help wondering if it isn’t a little bit pervy.

momofone

I feel a “but” lingering.

Nick Sanders

Ah, the good old one-size-fits-all cause, source of all modern medical ills. Baloney!

And you know Cory is low risk? You’re sure she’s not AMA, obese, you’re sure she’s been tested for gestational diabetes in a legitimate way, is having her urine and blood pressure checked every prenatal appointment? I didn’t see Cory mention she was going for a home birth or mention what kind of midwife she had. She may be receiving great care from a CNM who works alongside doctors and delivers in a hospital. Great for her if so. She had stated she is in the US so why are you giving her stuff from the NHS? You don’t know if she’s low risk and we can all tell you aren’t a medical professional in any capacity so don’t give her advice as if you are.

Jacob Bunton

Are American women any different from British women?
I don’t assume Cory is low risk or high risk. I hope she has continuity of care from a midwife she has come to know and trust because statistically she and baby will be better off.
Sandall et al 2015 – ‘Continuity of care: improving outcomes and experience’- shows that women with midwife-led continuity of care receive the following benefits;
• 16% less likely to lose their baby
• 19% less likely to lose their baby before 24 weeks
• 15% less likely to need regional analgesia
• 24% less likely to experience a pre-term birth
• 16% less likely to have an episiotomy •
• More likely to go into spontaneous labour and not need an induction •
• More likely to successfully breastfeed •
• Less fear and anxiety of childbirth •
• Less likely to have an instrumental delivery
• Less likely to have severe perineal trauma •
• Less likely to have a caesarean •
• Less likely their baby will need resuscitation and admission to a neonatal unit •
• Less likely to suffer postnatal depression

I don’t assume anything but it seems you assume a lot about me.

demodocus

The vast majority of midwives who are equivalent to UK midwives (i.e. nurses with advanced degrees, rather than high school graduates) work in the hospital.

Of -COURSE- they’re less likely to get a c-section; if the midwife is halfway decent, she’ll risk out most of her patients who’ll need one. Know many nurses who perform surgery, do you?

Of -COURSE- they’re less likely to get an episiotomy or an induction, or get regional analgesia; these in the US and probably the UK are handled by MDs. In related news, people who give birth in taxis are also far less likely to need these..

In the UK, high risk patients are seen by OBs, so people who are more likely to loose a baby or who’s baby is known to have lung, heart, or other congenital abnormalities will be seen in hospital.

No one I know except the one person with clinical anxiety who’d be worried no matter where she gave birth was in the least bothered by having their children in the hospital. In fact, some of us feel better about it, because if something -does- go wrong, it can get fixed right there. I gave birth down the hall from one of the best NICUs in the country.

Homebirth midwives in the US are half-trained amateurs. I’d rather stick with the taxi driver, who at least knows she’s out of her depth!

As far as the ppd stuff goes? Go away you blithering git. What you know about it could probably be written on parchment and stuffed in a thimble.

Poogles

“Are American women any different from British women?”

Not necessarily (though, IIRC, American women do have higher rates of obesity), but the healthcare systems have *vast* differences and the US has people who can call themselves “midwives” and attend births outside of hospitals with very little training or experience and without having any system in place to handle transfers to hospitals, let alone ensuring continuity of care after the transfer (these “midwives” cannot practice in hospital, so at most they can stick around as a “support person” or “doula” – but most do not).

momofone

You hope she’s left this site? So she won’t question what she’s been sold, I presume. No danger in questioning unless you’re afraid of the answers.

blargh

In the US, no babies were given thalidomide. You don’t give that to babies.

Nor were their mothers given thalidomide, because it was never approved for use.

The Bofa on the Sofa

Yes, there needs to be learning from incidents, and development where needed. But blaming one professional group, or a particular type of birth, does little to improve any situation.

When the activities of a group can be identified as leading to those incidents, um, you damn straight it makes sense to blame them!

But that is the starting point. Next you expect them to change.

Do a root cause analysis. Find the source of the problem. Fix it.

Christytrustin

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Sheven

I’m sure if a report showed that doctors were encouraging a practice that lead to death and injury, Sheena would absolutely still insist that no professional group be held responsible.

demodocus

They overrate “normal.”

The Bofa on the Sofa

Death is perfectly normal. Hell, we all do it at one point or another.

I fail to see the virtue in the concept of “normal.”

Mark

Normal = Natural

Natural fallacy is the ‘new religion’

Amy Tuteur, MD

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com...
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